Kidney Week

Abstract: SA-PO0513

Serum Aldosterone and Kidney and Cardiovascular Outcomes in US Veterans

Session Information

• CKD: Clinical - Therapies, CKM Health, Special Populations, and More
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2202 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Gyamlani, Geeta G., The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Geeta G. Gyamlani, MD, FASN

• Shrestha, Prabin, The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Prabin Shrestha, PhD

• Valaulikar, Riya, The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Riya Valaulikar

• Zabiullah, Syed Mohammed Faizaan, The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Syed Mohammed Faizaan Zabiullah, MBBS

• Sumida, Keiichi, The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Keiichi Sumida, MD, PhD, MPH, FASN

• Kalantar-Zadeh, Kamyar, Harbor-UCLA Medical Center, Torrance, California, United States

Kamyar Kalantar-Zadeh, MD, DrMed, PhD, MPH, FASN

• Kovesdy, Csaba P., The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Csaba P. Kovesdy, MD, FASN

Background

Aldosterone promotes sodium retention, fibrosis, and vascular remodeling, with potential roles in CKD progression, ESKD, and cardiovascular events. Understanding its independent association with renal and cardiovascular outcomes may help guide targeted therapies and risk stratification in diabetic and non-diabetic patients.

Methods

In this nationwide cohort of 3,582,478 U.S. veterans with baseline eGFR ≥60 ml/min/1.73m², we identified 36,529 patients with measured serum aldosterone (SA). Associations between SA (continuous and quartiles) and risk of ESKD and death were evaluated using Cox regression, adjusting for demographics, socioeconomic factors, blood pressure, comorbidities, medications, and laboratory values including eGFR and potassium.

Results

Participants had mean age 62±11 years, BMI 30.5±6.3, eGFR 77±22 ml/min/1.73m², and BP 145±24/82±15 mmHg. Median SA was 9 (5–15) ng/dl; potassium was 4.0 (3.6–4.4) mEq/L. The cohort was 93% male, 37% diabetic, and 84% hypertensive. Higher SA (per 1 log-unit) was associated with lower mortality in both unadjusted (HR 0.83 [0.80–0.85], p<0.0001) and adjusted (HR 0.93 [0.90–0.96], p<0.0001) models, with no association with ESKD. The lowest-quartile of SA was associated with higher mortality but no difference in ESKD risk (Figure).

Conclusion

Serum aldosterone levels were not associated with increased risk of ESKD and were inversely associated with mortality. These seemingly counterintuitive results may be explained by unmeasured confounding from treatment-related effects in patients undergoing aldosterone evaluation or from surreptitious volume overload in patients with suppressed SA levels.

Funding

• NIDDK Support