Renin-Independent Aldosteronism Heightened the Risk of Renal Impairment in Chinese Adults From Hakka Biobank

Rationale & Objective The differential impact of renin-independent aldosteronism versus renin-dependent aldosteronism on renal function—particularly urinary albumin/creatinine ratio (UACR), estimated glomerular filtration rate (eGFR), and their combination—remains unclear in the Chinese Hakka population. This study aimed to compare their associations with renal impairment. Study Design Cross-sectional analysis. Setting & Participants 7,760 adults from the Hakka Biobank in Bobai County, Guangxi, China. Exposures Aldosteronism phenotypes (renin-independent aldosteronism, renin-dependent aldosteronism, control) defined by plasma aldosterone concentration (PAC) and plasma renin concentration (PRC). Outcomes CKD-UACR (UACR ≥ 3 mg/mmol), CKD-eGFR (eGFR < 60 mL/min/1.73 m 2 ), and CKD-combination (defined as participants classified as having moderate, high, or very-high CKD risk according to KDIGO 2024). Analytical Approach Multivariable logistic and linear regression, restricted cubic splines, and stratified analysis. Results Renin-independent aldosteronism was associated with higher CKD-combination risk than renin-dependent aldosteronism (OR = 1.21, 95% CI: 1.02 – 1.45, P = 0.03). Elevated PAC (but not PRC or ARR) was consistently associated with all CKD outcomes in both groups (OR range: 1.49 – 13.77, P < 0.05). A linear dose-response relationship was observed in renin-independent aldosteronism, while renin-dependent aldosteronism showed both linear and nonlinear trends. Aldosterone interacted with hyperuricemia and hypertension in renin-independent aldosteronism, and with dyslipidemia in renin-dependent aldosteronism. Limitations Cross-sectional design precludes causal inference; findings are specific to the Hakka population. Conclusions Renin-independent aldosteronism confers a higher risk of renal impairment than renin-dependent aldosteronism in the Chinese Hakka population, highlighting the need for early screening and targeted intervention in renin-independent aldosteronism. Plain-Language Summary Chronic kidney disease is a growing global health burden, often undetected until later stages. Aldosterone, a hormone that regulates blood pressure, can also harm the kidneys. This study explored whether the way aldosterone is produced—with or without its usual trigger, renin—affects kidney health differently in a specific Chinese population. We analyzed data from over 7,700 adults, comparing kidney function across groups with different aldosterone patterns. We found that individuals with renin-independent aldosterone production had a higher risk of kidney impairment than those with the renin-dependent type. Elevated aldosterone itself was the key driver of this risk. This suggests that screening for this specific hormone pattern could help identify people at greater risk for kidney disease, allowing for earlier intervention.