Independent Association Between Elevated Aldosterone Levels and Early Renal Impairment in Hypertensive Women: A Cross-sectional Study

Background The RAAS system contributes to kidney damage through non-hemodynamic effects, yet the role of plasma aldosterone (ALD) in predicting early renal dysfunction (ERD) in women remains underexplored. This study aims to evaluate the diagnostic potential of ALD in identifying early renal dysfunction in women with essential hypertension, addressing a gap in current research. Methods In this cross-sectional study, we evaluated 211 women with essential hypertension who had not been treated with RAAS inhibitors. Based on ACR and eGFR, participants were categorized into the ERD group and the non-renal dysfunction (NRD) group. To investigate the relationship between aldosterone and renal function, we conducted Spearman correlation analysis and multivariate logistic regression. In order to further assess its diagnostic efficacy, ROC curves were used to determine the optimal aldosterone cutoff value, while also analyzing the predictive power of renal function biomarkers. Results ALD correlated positively with ACR and negatively with eGFR. Multivariate regression analysis revealed that ALD is an independent predictor of ERD, acting alongside age. In terms of diagnostic predictive value, the optimal cutoff for ALD was 159.2 pg/mL, with an AUC of 0.715, sensitivity of 74.3%, and specificity of 62.5%. ROC curve analysis following aldosterone grouping showed that its diagnostic performance was similar to ACR (AUC = 0.733), but significantly outperformed eGFR (AUC = 0.599) and tubular markers. ALD grouping effectively identified high-risk renal dysfunction groups, particularly in early renal damage patients who were not detected in a timely manner by traditional biomarkers, demonstrating higher sensitivity and specificity. Conclusion ALD is a strong predictor of ERD in hypertensive women, and its reliability as an independent predictor has been confirmed. The optimal cutoff value of 159.2 pg/mL provides a practical tool for risk stratification. Combining ALD screening with ACR enhances the detection of kidney function risk, particularly in cases of early renal damage where eGFR and other biomarkers remain normal. This approach further improves diagnostic sensitivity and specificity.