Aldosterone-to-renin ratio (ARR) as a screening tool for primary aldosteronism (PA)

Chia-Hung Lin; Ching-Han Lin; Mu-Chi Chung; Chi-Sheng Hung; Fen-Yu Tseng; Leay Kiaw Er; Charles Jia-Yin Hou; Yen-Hung Lin; Vin-Cent Wu; Hao-Min Cheng; Hsien-Li Kao; Kwan-Dun Wu; Tai-Shuan Lai

doi:10.1016/j.jfma.2023.04.019

Aldosterone-to-renin ratio (ARR) as a screening tool for primary aldosteronism (PA)

J Formos Med Assoc. 2024 Mar:123 Suppl 2:S98-S103. doi: 10.1016/j.jfma.2023.04.019. Epub 2023 May 10.

Authors

Chia-Hung Lin¹, Ching-Han Lin², Mu-Chi Chung³, Chi-Sheng Hung⁴, Fen-Yu Tseng⁵, Leay Kiaw Er⁶, Charles Jia-Yin Hou⁷, Yen-Hung Lin⁸, Vin-Cent Wu⁹, Hao-Min Cheng¹⁰, Hsien-Li Kao¹¹, Kwan-Dun Wu¹², Tai-Shuan Lai¹³

Affiliations

¹ Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
² Division of Endocrinology and Metabolism, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
³ Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
⁴ Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
⁵ Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Medical Education, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan.
⁶ Division of Endocrinology, Department of Internal Medicine, Taipei Tzu-Chi Hospital, Buddhist Tzu-Chi Medical Foundation, New Taipei City, Taiwan; School of Medicine, Tzu-Chi University, Hualien, Taiwan.
⁷ Cardiovascular Center, MacKay Memorial Hospital, Taipei, Taiwan.
⁸ Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Primary Aldosteronism Center at National Taiwan University Hospital, Taiwan.
⁹ Primary Aldosteronism Center at National Taiwan University Hospital, Taiwan; Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
¹⁰ Ph.D. Program of Interdisciplinary Medicine (PIM), National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan; Division of Faculty Development, Taipei Veterans General Hospital, Taiwan; Center for Evidence-based Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Public Health, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan; Institute of Health and Welfare Policy, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan.
¹¹ Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan.
¹² Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
¹³ Primary Aldosteronism Center at National Taiwan University Hospital, Taiwan; Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: d99849016@ntu.edu.tw.

PMID: 37173226
DOI: 10.1016/j.jfma.2023.04.019

Abstract

The aldosterone-to-renin ratio (ARR) is the standard screening test for primary aldosteronism (PA). Because of the poor reproducibility of the ARR, repeat testing is recommended if the result is not compatible with the clinical condition. Various methods to measure renin are used in different hospitals in Taiwan, and the ARR cutoff values also differ among laboratories. The Task Force of Taiwan PA recommend using plasma renin activity (PRA) to calculate ARR instead of direct renin concentration (DRC) unless PRA is unavailable, because PRA is widely used in international guidelines and most studies.

Keywords: Aldosterone; Aldosterone-to-renin ratio; Primary aldosteronism; Renin; Screening.

Publication types

Review

MeSH terms

Aldosterone
Hospitals
Humans
Hyperaldosteronism* / diagnosis
Hypertension* / etiology
Renin
Reproducibility of Results

Substances

Aldosterone
Renin