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Background <p>Primary aldosteronism (PA), the most common endocrine cause of secondary hypertension, remains underdiagnosed in type 2 diabetes mellitus (T2DM) despite its established role in exacerbating hypertension, dysglycemia, and cardiovascular risk. This retrospective cohort study systematically analyzed the prevalence and renal consequences of PA in hospitalized T2DM patients using historical clinical data.</p> Methods <p>We enrolled 769 consecutive adults with T2DM from a tertiary endocrine center (2018–2022). Standardized protocol was implemented for acquiring demographic characteristics and anthropometric parameters, complemented by biochemical profiling through serum biomarker analysis. PA screening followed Endocrine Society guidelines: positive screening required aldosterone-to-renin ratio (ARR) ≥ 20 (ng/dL)/(ng/mL/h), a plasma aldosterone concentration (PAC) ≥ 8 ng/dL, and a plasma renin activity (PRA) &lt; 1 ng/mL/h. Confirmatory diagnosis required post-seated saline suppression test PAC ≥ 10 ng/dL and/or post-captopril challenge test PAC &gt; 11 ng/dL with ≤ 30% reduction from baseline. Multivariable logistic regression was employed to assess the association between PA status and the risk of progression to end-stage renal disease (ESRD) in patients with diabetic kidney disease (DKD). Two-sample Mendelian randomization (MR) analysis was used to investigate the causal association between PA and DKD.</p> Results <p>Of the 769 patients, 324 (42.1%) screened positive for PA, with 88 out of 130 (67.7%) confirmatory-test-positive cases establishing a minimum PA prevalence of 11.4% [95% confidence intervals (CI): 9.2–13.7%]. PA patients exhibited higher hypertension prevalence (84.1% vs. 50.5%, <i>P</i> &lt; 0.001), more familial hypertension (43.2% vs. 20.1%, <i>P</i> &lt; 0.001), lower serum potassium (3.5 vs. 3.9 mmol/L, <i>P</i> &lt; 0.001), and better metabolic control (HbA1c: 7.0% vs. 9.1%, <i>P</i> &lt; 0.001; LDL-C: 2.75 vs. 3.25 mmol/L, <i>P</i> = 0.002). Despite a more favorable metabolic profile, patients with PA had a 1.7-fold higher prevalence of DKD (48.9% vs. 29.0%, <i>P</i> &lt; 0.001). Even after adjustment for age, sex, blood pressure, blood glucose, and lipid levels, these patients exhibited a 3.3-fold increased risk of progressing to ESRD over 24 months (adjust odds ratio [OR] = 3.291, 95% CI: 1.035–10.464; <i>P</i> = 0.044). MR analysis confirmed PA’s causal effect on DKD (Inverse-variance weighted, OR = 1.03, 95% CI:1.01–1.05, <i>P</i> = 0.002).</p> Conclusions <p>PA affects at least 11.4% of hospitalized T2DM patients, driving disproportionate renal risk despite favorable metabolic profiles.</p>

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High prevalence of primary aldosteronism and its impact on diabetic kidney disease in type 2 diabetes mellitus: A retrospective cohort study

  • 期刊论文

  • 发表日期：

    2026年1月21日

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  • Xiaoqin Ma,
  • Xiaochun Lin,
  • Nannan Liu,
  • Yanmei Zeng,
  • Lei Guo,
  • Qijian Feng,
  • Minghai Wu,
  • Feifei Cai,
  • Yuxuan Hu,
  • Yuan Wang,
  • Jin Zhang,
  • Huiyun Wang,
  • Linlin Tian,
  • Xinzhao Fan,
  • Yaoming Xue,
  • Meiping Guan

摘要

Background

Primary aldosteronism (PA), the most common endocrine cause of secondary hypertension, remains underdiagnosed in type 2 diabetes mellitus (T2DM) despite its established role in exacerbating hypertension, dysglycemia, and cardiovascular risk. This retrospective cohort study systematically analyzed the prevalence and renal consequences of PA in hospitalized T2DM patients using historical clinical data.

Methods

We enrolled 769 consecutive adults with T2DM from a tertiary endocrine center (2018–2022). Standardized protocol was implemented for acquiring demographic characteristics and anthropometric parameters, complemented by biochemical profiling through serum biomarker analysis. PA screening followed Endocrine Society guidelines: positive screening required aldosterone-to-renin ratio (ARR) ≥ 20 (ng/dL)/(ng/mL/h), a plasma aldosterone concentration (PAC) ≥ 8 ng/dL, and a plasma renin activity (PRA) < 1 ng/mL/h. Confirmatory diagnosis required post-seated saline suppression test PAC ≥ 10 ng/dL and/or post-captopril challenge test PAC > 11 ng/dL with ≤ 30% reduction from baseline. Multivariable logistic regression was employed to assess the association between PA status and the risk of progression to end-stage renal disease (ESRD) in patients with diabetic kidney disease (DKD). Two-sample Mendelian randomization (MR) analysis was used to investigate the causal association between PA and DKD.

Results

Of the 769 patients, 324 (42.1%) screened positive for PA, with 88 out of 130 (67.7%) confirmatory-test-positive cases establishing a minimum PA prevalence of 11.4% [95% confidence intervals (CI): 9.2–13.7%]. PA patients exhibited higher hypertension prevalence (84.1% vs. 50.5%, P < 0.001), more familial hypertension (43.2% vs. 20.1%, P < 0.001), lower serum potassium (3.5 vs. 3.9 mmol/L, P < 0.001), and better metabolic control (HbA1c: 7.0% vs. 9.1%, P < 0.001; LDL-C: 2.75 vs. 3.25 mmol/L, P = 0.002). Despite a more favorable metabolic profile, patients with PA had a 1.7-fold higher prevalence of DKD (48.9% vs. 29.0%, P < 0.001). Even after adjustment for age, sex, blood pressure, blood glucose, and lipid levels, these patients exhibited a 3.3-fold increased risk of progressing to ESRD over 24 months (adjust odds ratio [OR] = 3.291, 95% CI: 1.035–10.464; P = 0.044). MR analysis confirmed PA’s causal effect on DKD (Inverse-variance weighted, OR = 1.03, 95% CI:1.01–1.05, P = 0.002).

Conclusions

PA affects at least 11.4% of hospitalized T2DM patients, driving disproportionate renal risk despite favorable metabolic profiles.