Annie Hung1, Sumaiya Ahmed1, Ankur Gupta2, Alexandra Davis3, Gregory A Kline4, Alexander A Leung4,5, Marcel Ruzicka6, Swapnil Hiremath6, Gregory L Hundemer6. 1. Department of Medicine, Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada. 2. Department of Medicine (Division of Nephrology), Whakatane Hospital, Whakatane, New Zealand. 3. Royal Ottawa Mental Health Centre, Ottawa, ON,Canada. 4. Department of Medicine (Division of Endocrinology and Metabolism), Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. 5. Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. 6. Department of Medicine (Division of Nephrology) and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON,Canada.
Abstract
CONTEXT: The aldosterone to renin ratio (ARR) is the guideline-recommended screening test for primary aldosteronism. However, there are limited data in regard to the diagnostic performance of the ARR. OBJECTIVE: To evaluate the sensitivity and specificity of the ARR as a screening test for primary aldosteronism. METHODS: We searched the MEDLINE, Embase, and Cochrane databases until February 2020. Observational studies assessing ARR diagnostic performance as a screening test for primary aldosteronism were selected. To limit verification bias, only studies where dynamic confirmatory testing was implemented as a reference standard regardless of the ARR result were included. Study-level data were extracted and risk of bias and applicability were assessed using the QUADAS-2 tool. RESULTS: Ten studies, involving a total of 4110 participants, were included. Potential risk of bias related to patient selection was common and present in half of the included studies. The population base, ARR positivity threshold, laboratory assay, and reference standard for confirmatory testing varied substantially between studies. The reported ARR sensitivity and specificity varied widely with sensitivity ranging from 10% to 100% and specificity ranging from 70% to 100%. Notably, 3 of the 10 studies reported an ARR sensitivity of <50%, suggesting a limited ability of the ARR to adequately identify patients with primary aldosteronism. CONCLUSIONS: ARR performance varied widely based on patient population and diagnostic criteria, especially with respect to sensitivity. Therefore, no single ARR threshold for interpretation could be recommended. Limitations in accuracy and reliability of the ARR must be recognized in order to appropriately inform clinical decision-making.
CONTEXT: The aldosterone to renin ratio (ARR) is the guideline-recommended screening test for primary aldosteronism. However, there are limited data in regard to the diagnostic performance of the ARR. OBJECTIVE: To evaluate the sensitivity and specificity of the ARR as a screening test for primary aldosteronism. METHODS: We searched the MEDLINE, Embase, and Cochrane databases until February 2020. Observational studies assessing ARR diagnostic performance as a screening test for primary aldosteronism were selected. To limit verification bias, only studies where dynamic confirmatory testing was implemented as a reference standard regardless of the ARR result were included. Study-level data were extracted and risk of bias and applicability were assessed using the QUADAS-2 tool. RESULTS: Ten studies, involving a total of 4110 participants, were included. Potential risk of bias related to patient selection was common and present in half of the included studies. The population base, ARR positivity threshold, laboratory assay, and reference standard for confirmatory testing varied substantially between studies. The reported ARR sensitivity and specificity varied widely with sensitivity ranging from 10% to 100% and specificity ranging from 70% to 100%. Notably, 3 of the 10 studies reported an ARR sensitivity of <50%, suggesting a limited ability of the ARR to adequately identify patients with primary aldosteronism. CONCLUSIONS: ARR performance varied widely based on patient population and diagnostic criteria, especially with respect to sensitivity. Therefore, no single ARR threshold for interpretation could be recommended. Limitations in accuracy and reliability of the ARR must be recognized in order to appropriately inform clinical decision-making.
Authors: Graeme Eisenhofer; Max Kurlbaum; Mirko Peitzsch; Georgiana Constantinescu; Hanna Remde; Manuel Schulze; Denise Kaden; Lisa Marie Müller; Carmina T Fuss; Sonja Kunz; Sylwia Kołodziejczyk-Kruk; Sven Gruber; Aleksander Prejbisz; Felix Beuschlein; Tracy Ann Williams; Martin Reincke; Jacques W M Lenders; Martin Bidlingmaier Journal: J Clin Endocrinol Metab Date: 2022-04-19 Impact factor: 6.134