Test characteristics of the aldosterone-to-renin ratio as a screening test for primary aldosteronism

2014 ◽  
Vol 32 (1) ◽  
pp. 115-126 ◽  
Author(s):  
Pieter M. Jansen ◽  
Bert-Jan H. van den Born ◽  
Wijnanda J. Frenkel ◽  
Emile L.E. de Bruijne ◽  
Jaap Deinum ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Screening Test ◽  
Test Characteristics ◽  
Aldosterone To Renin Ratio

scholarly journals Aldosterone to Renin Ratio as Screening Tool in Primary Aldosteronism

2018 ◽  
Vol 127 (02/03) ◽  
pp. 84-92
Author(s):  
Katharina Schilbach ◽  
Riia Junnila ◽  
Martin Bidlingmaier
Keyword(s):  
Primary Aldosteronism ◽  
Screening Test ◽  
Screening Tool ◽  
Secondary Hypertension ◽  
Hypertensive Patients ◽  
Assay Methods ◽  
Aldosterone To Renin Ratio

AbstractPrimary aldosteronism (PA) is a severe and often underdiagnosed form of secondary hypertension. Determining the aldosterone to renin ratio (ARR) in hypertensive patients has been shown to be a valuable screening test for identification of patients suffering from PA. Since the introduction of a more widespread ARR screening the number of PA patients significantly increased worldwide. Interpretation of ARR might be challenging: Several factors from posture to interfering drugs affect the ARR and need to be taken into account when collecting samples. In addition, the wide variety of available assay methods and lack of well-established cut-offs present a challenge to the clinician. This review discusses the usefulness and possible difficulties of ARR screening.

The Aldosterone-to-Renin Ratio as a Screening Test in Primary Aldosteronism

2021 ◽  
Vol 14 (63) (1) ◽  
pp. 29-36
Author(s):  
Manuela Mocanu ◽  
Claudia Alexandrina Irimie ◽  
Mihai Stelian Vârciu ◽  
Marius Irimie
Keyword(s):  
Primary Aldosteronism ◽  
Screening Test ◽  
Target Population ◽  
Secondary Hypertension ◽  
Primary Hypertension ◽  
Primary Hyperaldosteronism ◽  
Common Causes ◽  
Aldosterone To Renin Ratio

Primary hyperaldosteronism is one of the most common causes of secondary hypertension and it is associated with a higher risk of developing extracardiac complications than that of people diagnosed with primary hypertension. We present a six-month study done at the MedLife Hospital in Brașov on 62 patients who had one or more indications for primary hyperaldosteronism screening. The main conclusions drawn from this study are that there is a strong need for starting screening in primary hyperaldosteronism from an earlier age, as the target population can have a high vulnerability from a cardiovascular and a renal standpoint and that the aldosterone-to-renin ratio screening test should be recommended to a higher number of people in the target population, the positivity rate in the group studied being 47%.

Performance of the Aldosterone-to-Renin Ratio as a Screening Test for Primary Aldosteronism: A Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Annie Hung ◽  
Sumaiya Ahmed ◽  
Ankur Gupta ◽  
Alexandra Davis ◽  
Gregory A Kline ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Primary Aldosteronism ◽  
Screening Test ◽  
Diagnostic Performance ◽  
Clinical Decision Making ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Reference Standard ◽  
Confirmatory Testing ◽  
Aldosterone To Renin Ratio

Abstract Context The aldosterone-to-renin ratio (ARR) is the guideline-recommended screening test for primary aldosteronism. However, there is limited data in regard to the diagnostic performance of the ARR. Objective To evaluate the sensitivity and specificity of the ARR as a screening test for primary aldosteronism. Data Sources We searched MEDLINE, Embase, and Cochrane until February 2020. Study Selection Observational studies assessing ARR diagnostic performance as a screening test for primary aldosteronism were selected. To limit verification bias, only studies where dynamic confirmatory testing was implemented as a reference standard regardless of the ARR result were included. Data Extraction Study-level data was extracted and risk of bias and applicability were assessed using the QUADAS-2 tool. Data Synthesis Ten studies, involving a total of 4,110 participants, were included. Potential risk of bias related to patient selection was common and present in half of the included studies. The population base, ARR positivity threshold, laboratory assay, and reference standard for confirmatory testing varied substantially between studies. The reported ARR sensitivity and specificity varied widely with sensitivity ranging from 10-100% and specificity ranging from 70-100%. Notably, four of the ten studies reported an ARR sensitivity of <50% suggesting a limited ability of the ARR to adequately identify patients with primary aldosteronism. Conclusions ARR performance varied widely based on patient population and diagnostic criteria, especially with respect to sensitivity. Therefore, no single ARR threshold for interpretation could be recommended. Limitations in accuracy and reliability of the ARR must be recognized in order to appropriately inform clinical decision-making.

Evaluation of Biochemical Conditions Allowing Bypass of Confirmatory Testing in The Workup of Primary Aldosteronism: A Retrospective Study in a French Hypertensive Population

2019 ◽  
Vol 51 (03) ◽  
pp. 172-177 ◽  
Author(s):  
Maud Vivien ◽  
Emilie Deberles ◽  
Remy Morello ◽  
Aimi Haddouche ◽  
David Guenet ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Dynamic Testing ◽  
Challenge Test ◽  
Plasma Aldosterone ◽  
Aldosterone Secretion ◽  
Plasma Aldosterone Concentration ◽  
Hypertensive Patients ◽  
Hypertensive Population ◽  
Tertiary Center ◽  
Aldosterone To Renin Ratio

AbstractThe diagnostic workup for primary aldosteronism includes a screening step using the aldosterone-to-renin ratio (ARR) and a confirmatory step based on dynamic testing of aldosterone secretion autonomy. International guidelines suggest that precise clinical and biochemical conditions may allow the bypassing of the confirmatory step, however, data which validate hormone thresholds defining such conditions are lacking. At our tertiary center, we retrospectively examined a cohort of 173 hypertensive patients screened for PA by the ARR, of whom 120 had positive screening and passed a saline infusion test (SIT) or a captopril challenge test (CCT). Fifty-nine had PA, including 34 Conn adenomas and 25 with idiopathic aldosteronism (IA). Using a threshold of 160 pmol/l, post-SIT plasma aldosterone concentration (PAC) identified PA with 86.4% sensitivity, 94.7% specificity, and a negative predictive value of 92.3%. Of those subjects with a high ARR and a PAC above 550 pmol/l, 93% had a positive SIT, while 100% of subjects with a high ARR, but a PAC under 240 pmol/l had a negative SIT. Our results thus validate the biochemical conditions defined in the French and US guidelines for bypassing the confirmatory step in the workup for PA diagnosis.

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