title: Plasma renin activity and the aldosterone-to-renin ratio are associated with the development of chronic kidney disease:  the Ohasama Study.
abstract: BACKGROUND
  The aldosterone-to-renin ratio (ARR) is used to screen for primary aldosteronism and could be an index for salt sensitivity. The association between ARR and the development of chronic kidney disease (CKD) is completely unknown.
  
  
  METHODS
  A longitudinal observational study involving 689 participants from a general Japanese population (mean age 58.2 years; 68.5% women) who did not have CKD and were not receiving antihypertensive medication at baseline was conducted. The estimated glomerular filtration rate (eGFR) was calculated from serum creatinine levels, and CKD was defined as eGFR less than 60 ml/min per 1.73 m(2) and/or dipstick-positive proteinuria. The associations of baseline plasma renin activity (PRA), plasma aldosterone concentration, and ARR with the development of CKD were examined using Cox proportional hazard regression analysis adjusted for sex, age, BMI, smoking, drinking, history of hypercholesterolemia, diabetes mellitus, and cardiovascular disease, SBP, and baseline eGFR.
  
  
  RESULTS
  During a mean 9.1-year follow-up, 118 participants developed CKD. A 1 standard deviation increment in the natural log-transformed (ln) ARR was positively associated with the incidence of CKD (hazard ratio 1.29, P = 0.012). LnPRA showed an inverse association (hazard ratio 0.76, P = 0.007). Meanwhile, plasma aldosterone concentration was not associated with CKD. Individuals who developed CKD had significantly lower baseline PRA (0.97 vs. 1.14 ng/ml per h; P = 0.03) and higher baseline ARR levels [66.6 vs. 56.8 (pg/ml)/(ng/ml per h); P = 0.02] than those who did not.
  
  
  CONCLUSIONS
  Lower PRA and higher ARR were associated with the development of CKD in a general population, suggesting that they are independent predictors of CKD.
authors.affiliation: Tohoku University Graduate School of Medicine and Pharmaceutical Sciences, Sendai, Japan.
authors.forename: Shiho
authors.initials: S
authors.lastname: Terata
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kikuya
authors.forename: Michihiro
authors.initials: M
authors.lastname: Satoh
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Ohkubo
authors.forename: Takanao
authors.initials: T
authors.lastname: Hashimoto
authors.forename: Azusa
authors.initials: A
authors.lastname: Hara
authors.forename: Takuo
authors.initials: T
authors.lastname: Hirose
authors.forename: Taku
authors.initials: T
authors.lastname: Obara
authors.forename: Hirohito
authors.initials: H
authors.lastname: Metoki
authors.forename: Ryusuke
authors.initials: R
authors.lastname: Inoue
authors.forename: Kei
authors.initials: K
authors.lastname: Asayama
authors.forename: Atsuhiro
authors.initials: A
authors.lastname: Kanno
authors.forename: Kazuhito
authors.initials: K
authors.lastname: Totsune
authors.forename: Haruhisa
authors.initials: H
authors.lastname: Hoshi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Satoh
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sato
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Imai
mesh_terms: D000450:Aldosterone / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000502:physiology; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011507:Proteinuria / Q000175:diagnosis; D012083:Renin / Q000097:blood*; D055049:Salt Tolerance
chemical_list: D015415:Biomarkers; D000450:Aldosterone; D003404:Creatinine; D012083:Renin