Key result
Urinary aldosterone levels after saline infusion had similar diagnostic accuracy to plasma aldosterone concentrations for diagnosing unilateral primary aldosteronism (AUC 0.921 vs 0.958; P=0.370).
Why the study?
Reliable studies on the diagnostic value of urinary aldosterone levels to confirm primary aldosteronism are limited, likely due to difficulties with accurate urine collection and inconsistent oral sodium intake.
Does 24-hour urinary aldosterone measurement after saline infusion accurately determine primary aldosteronism subtypes compared to plasma aldosterone concentration?
Cross-Sectional (n=53)
No
Does 24-hour urinary aldosterone measurement after saline infusion accurately determine primary aldosteronism subtypes compared to plasma aldosterone concentration?
Absolute Event Rate: 0.921% vs 0.958%
p-value: p=0.370
24-hour urinary aldosterone measurement after saline infusion provides comparable diagnostic accuracy to plasma aldosterone concentration for determining primary aldosteronism subtypes.
Urinary aldosterone after saline infusion shows comparable accuracy to plasma aldosterone for unilateral PA subtyping; leaves open routine adoption pending prospective validation.
Context Urinary aldosterone levels (Uald) are widely measured in the oral sodium-loading test to confirm primary aldosteronism (PA), but reliable studies on their diagnostic value are limited. This may be due to the difficulty in collecting urine with reliable accuracy, keeping oral sodium intake constant between patients. Therefore, we focused on 24-hour Uald after intravenous saline infusion in a hospitalized setting, which provides a reliable sodium load in consistent amounts. Objective Comparing plasma aldosterone concentrations (PAC) and Uald after saline infusion in the sitting position, to evaluate the accuracy in determining PA subtypes and the correlation of both measurements. Design and Setting This was a retrospective cross-sectional study in a single referral center. Patients Of 53 patients without renal dysfunction who were diagnosed with PA and underwent adrenal venous sampling, 16 and 37 were diagnosed with unilateral and bilateral PA, respectively. Main Outcome Measures Uald collected for 24 hours and PAC after saline infusion. Results The area under the receiver operating characteristic curve for diagnosing unilateral PA was not significantly different between Uald and PAC after saline infusion (0.921 and 0.958, respectively; P = 0.370). The predicted optimal cutoff value of Uald was 16.5 μg/day (sensitivity, 87.5%; specificity, 100%), and that of PAC after saline infusion was 19.3 ng/dL (sensitivity, 87.5%; specificity, 97.3%). In studied patients with PA, Uald was positively correlated with PAC after saline infusion (r = 0.617; P < 0.001). Conclusions We reassessed Uald in PA patients under sufficient sodium loading and demonstrated the correlation between Uald and PAC after saline infusion.
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Kaneko et al. (2020) conducted a cross-sectional in Primary aldosteronism (n=53). Urinary aldosterone measurement after saline infusion vs. Plasma aldosterone concentration after saline infusion was evaluated on Area under the receiver operating characteristic curve for diagnosing unilateral primary aldosteronism (p=0.370). Urinary aldosterone levels after saline infusion had similar diagnostic accuracy to plasma aldosterone concentrations for diagnosing unilateral primary aldosteronism (AUC 0.921 vs 0.958; P=0.370).
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