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- Title
A 120-Minute Saline Infusion Test for the Confirmation of Primary Aldosteronism: A Pilot Study.
- Authors
Golani, Tiran; Bleier, Jonathan; Kaplan, Alon; Hod, Tammy; Sharabi, Yehonatan; Leibowitz, Avshalom; Grossman, Ehud; Shlomai, Gadi
- Abstract
BACKGROUND The saline infusion test (SIT) to confirm primary aldosteronism requires infusing 2 L of normal saline over 240 minutes. Previous studies raised concerns regarding increased blood pressure and worsening hypokalemia during SIT. We aimed to evaluate the diagnostic applicability of a SIT that requires 1 L of saline infusion over 120 minutes. METHODS A cross-sectional study, including all patients in a large medical center who underwent SIT from 1 January 2015 to 30 April 2023. Blood samples were drawn for baseline renin and aldosterone (t = 0) after 2 hours (t = 120 min) and after 4 hours (t = 240 min) of saline infusion. We used ROC analysis to evaluate the sensitivity and specificity of various aldosterone cut-off values at t = 120 to confirm primary aldosteronism. RESULTS The final analysis included 62 patients. A ROC analysis yielded 97% specificity and 90% sensitivity for a plasma aldosterone concentration (PAC) of 397 pmol/L (14 ng/dL) at t = 120 to confirm primary aldosteronism, and an area under the curve of 0.97 (95% CI [0.93, 1.00], P < 0.001). Almost half (44%) of the patients did not suppress PAC below 397 pmol/L (14 ng/dL) at t = 120. Of them, only one (4%) patient suppressed PAC below 276 pmol/L (10 ng/dL) at t = 240. Mean systolic blood pressure increased from 140.1 ± 21.3 mm Hg at t = 0 to 147.6 ± 14.5 mm Hg at t = 240 (P = 0.011). CONCLUSIONS A PAC of 397 pmol/L (14 ng/dL) at t = 120 has high sensitivity and specificity for primary aldosteronism confirmation.
- Subjects
HYPERALDOSTERONISM; SYSTOLIC blood pressure; PILOT projects; BLOOD pressure
- Publication
American Journal of Hypertension, 2024, Vol 37, Issue 6, p415
- ISSN
0895-7061
- Publication type
Article
- DOI
10.1093/ajh/hpae017