Abstract

A clinical condition may be missed due to its higher-than-recognized prevalence or inadequate diagnostic screening. Primary aldosteronism suffers from both of these factors and thus, is woefully underdiagnosed as a cause of hypertension and end-organ damage. Furthermore, screening tests should be strongly considered in diseases that pose significant morbidity or mortality if left untreated; have a high prevalence; and have treatments that lead to improvement or cure. In this review we present evidence on each of these points. We outline studies that estimate prevalence of primary aldosteronism in different at-risk populations and how the recognition has changed over time. We also evaluate myriad studies of screening rates for primary aldosteronism and what factors do and do not influence current screening practices. We discuss the ideal conditions for screening, the performance of the aldosterone-to-renin ratio in different populations that use plasma renin activity or direct renin concentration, and the steps for diagnostic work-up of primary aldosteronism. Finally, we conclude with potential strategies to implement higher rates of screening and diagnosis of this common, consequential, and treatable disease.

View details for DOI 10.1053/j.ajkd.2023.01.447

View details for PubMedID 36965825