SUN-242 Elevated urinary albumin-to-creatinine ratio (UACR) is associated with biochemical test results characteristic of primary aldosteronism (PA) and may identify PA patients in electronic medical records (EMR).

Abstract Disclosure: M. Marcelli: Quest Diagnostics, Employee. C. Bi: Quest Diagnostics, Employee. M.J. McPhaul: Quest Diagnostics, Employee. Compared to primary hypertension (HTN), hypertension (HTN) that is secondary to primary aldosteronism (PA) increases the risk of kidney disease 2-fold. An early indicator of renal dysfunction is urinary albumin-to-creatinine ratio (UACR) ≥ 30 mg/g. This study aimed to investigate whether the frequency of this abnormality varies in concert with elevated biochemical markers characteristic of PA. We screened deidentified laboratory results from 2020 to 2024 and included cases in which plasma aldosterone concentration (PAC) and plasma renin activity (PRA) were requested to evaluate for PA, and where UACR and potassium (K) levels were available within 6 months. The study included 36,148 patients (cohort A). Using a PRA threshold of <1 ng/mL/h, presumptive PA was present in 47%. The % (95%CI) of biochemical abnormalities typical of PA increased in the presence of a UACR>30 mg/g: PRA<1 vs. ≥1, 37% (36-38) vs. 33% (32-33); K<3.5 mEq/L vs. ≥3.5, 47% (44-49) vs. 34% (33-34); PRA<1 and K<3.5 vs. PRA ≥ 1 and K≥3.5, 53% (50-55) vs. 32% (32-33); PAC (ng/dL) >15 vs 5-15, 39.4 (38-41) vs. 33.3% (32.7-33.9%). Multiple logistic regression analysis demonstrated increased odds ratios [OR (95%CI)] for UACR>30 mg/g in the presence of PAC>15 ng/mL: 1.25 (1.17-1.34); male sex: 1.55 (1.48-1.62); K<3.5: 1.65 (1.50-1.80); but not PAC 5-15: 0.96 (0.91-1.01) independently from T2D. The OR (95%CI) for a UACR >30 mg/g was further increased independently from T2DM when associating PAC 5-15 with male sex: 1.49 (1.42-1.55), K<3.5: 1.58 (1.48-1.68), or PRA < 1: 1.10 (1.03-1.17), and when associating PAC>15 with male sex: 1.94 (1.86-2.02), K<3.5: 2.06 (1.95-2.17), or PRA<1: 1.44 (1.35-1.52). The association of PAC 5-15 or >15 with male sex, K<3.5, and PRA <1 produced an OR (95%CI) of 2.81 (2.68-2.93) and 3.66 (3.53-3.79), respectively. When using UACR >30 as a screening tool to identify patients with the combination PRA <1 and PAC 5-15 or >15 in cohort A, the percentages identified were 35.4% (34.5-36.4) and 47.2% (45.2-49.1), respectively. Our findings indicate that a UACR >30 mg/g is associated with laboratory test results characteristic of PA independent of type 2 diabetes (T2D). Use of UACR >30 mg/g could serve as a novel method for screening large-scale electronic medical records to detect patients at higher risk for primary aldosteronism. Presentation: Sunday, July 13, 2025