The ARRplus : a model for renin-dependent and sex-specific aldosterone cut-offs that improves screening for primary aldosteronism

Clinical Chemistry and Laboratory Medicine (CCLM) 2026 Open access

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Authors: Sybille Fuld, Jun Yang, Georgiana Andreea Constantinescu, Christina Pamporaki, Francesco Alessi, Mirko Peitzsch, Manuel Schulze, Denise Brüdgam, Hanna Remde, Lydia Kürzinger, Carmina Teresa Fuß, Isabella Sudano
+7 more Sven Gruber, George Mangos, Tracy Ann Williams, Martin Reincke, Felix Beuschlein, Jacques W.M. Lenders, Graeme Eisenhofer
DOI: 10.1515/cclm-2025-1670
Cited by: 1
References: 40

Abstract

Abstract Objectives Screening for primary aldosteronism (PA) using the aldosterone:renin ratio (ARR) has suboptimal diagnostic accuracy, particularly in females. We assessed whether accuracy could be improved using sex-specific relationships of aldosterone with renin. Methods Plasma aldosterone and renin were measured in 442 females and 491 males prospectively screened for PA. Patients were divided into test (n=717) and validation (n=216) cohorts. Sex-specific cut-offs for renin-dependent aldosterone concentrations and the ARR were developed using logistic regression models in the test cohort. Diagnostic performance of models in both cohorts was compared to that of the ARR. Results Females without PA had higher (p

Fields of Study & Subjects

Hormonal Regulation and Hypertension Renin-Angiotensin System Studies Adrenal and Paraganglionic Tumors

Publication details

Journal / source
Clinical Chemistry and Laboratory Medicine (CCLM)
Publisher
Walter de Gruyter GmbH
Volume
64
Issue
6
Pages
1438–1449
Publication date
16 February 2026
Language
EN