Kidney Week

Abstract: SA-PO0471

Renin-Independent Aldosterone Production and Kidney Outcomes Beyond Primary Aldosteronism: Real-World Evidence from a Large Health Care Database

Session Information

• CKM: Clinical - Screening, Population Management, Care Disparities, and Patient-Centered Outcomes
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Cardiovascular-Kidney-Metabolic Health

• 602 Cardiovascular-Kidney-Metabolic Health: Clinical

Authors

• Treves, Nir, AstraZeneca Israel, Kfar Saba, Israel

Nir Treves, PhD

• Leiba, Adi, Joyce and Irving Goldman School of Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel

Adi Leiba, MD, FASN

• Berenheim, Mai, AstraZeneca Israel, Kfar Saba, Israel

Mai Berenheim

• Yahalom, Roni, AstraZeneca Israel, Kfar Saba, Israel

Roni Yahalom, DVM

• Admon, Meytal, AstraZeneca Israel, Kfar Saba, Israel

Meytal Admon, MSc, MBA

• Livnat, Idit, AstraZeneca Israel, Kfar Saba, Israel

Idit Livnat, PhD

• Yarden, Adva, AstraZeneca Israel, Kfar Saba, Israel

Adva Yarden

• Gross, Victor, Meuhedet Health Service, Israel, Tel Aviv, Israel

Victor Gross, MA

• Chodick, Gabriel, Tau-AZ Beam, Ramat Aviv, Tel Aviv, Israel

Gabriel Chodick, PhD

• Zacay, Galia, Meuhedet Health Service, Israel, Tel Aviv, Israel

Galia Zacay, MD, MPH

Background

Aldosterone has been implicated in renal pathologies when produced independently of renin regulation. Beyond classical primary aldosteronism (PA), evidence suggests that renin-independent aldosterone production represents a broader continuum of inappropriate aldosterone activity contributing to adverse renal outcomes. While studies demonstrate associations between suppressed renin with elevated aldosterone and renal complications, the clinical significance and impact on progressive kidney disease remains incompletely characterized.

Methods

This real-world evidence study utilized the Israeli Meuhedet database to identify plasma aldosterone and renin tests performed within 7 days of each in adults>18 years. Index date was the latest test date. Groups below and above the cutoffs of aldosterone-to-renin ratio (ARR) = 1 pg/µIU, and renin levels = 8.2 µIU/mL are described. The exposure was assessed via aldosterone-to-renin ratio (ARR), aldosterone and renin as continuous variables. Primary outcomes included albuminuria onset, hypokalemia, end-stage renal disease etc. We examined associations between ARR, renin and aldosterone levels using Cox proportional hazard models, analyzing continuously with 4-knot splines, visualizing results as hazard ratios with 95% CIs.

Results

The baseline demographic and clinical profiles demonstrate substantial comparability between the two groups (5609 (81%) patients with ARR≤1 and 1287 (19%) patients with ARR≤1), with majority of females in both groups, mean age of 58-60 years, mean BMI>29.0, and mean eGFR>82 mL/min/1.73 m². Higher ARR was associated with increased adjusted HRs (aHRs) of the renal outcomes in cubic spline models. Low renin and high aldosterone levels were associated with increased aHRs of some renal outcomes.

Conclusion

Elevated aldosterone-to-renin ratio was associated with increased risk of adverse renal outcomes, indicating kidney damage in this large cohort study. These findings suggest that renin-independent aldosterone production may contribute to direct nephrotoxicity beyond classical PA.

Funding

• Commercial Support – AstraZeneca