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Exploring the relationship between hypertension, chronic kidney disease, and primary aldosteronism

Hypertension (HTN) affects nearly half of US adults1 and is the second leading cause of chronic kidney disease (CKD).2 Some individuals with hypertension have a particularly high risk of developing CKD due to primary aldosteronism (PA). PA is the leading endocrine cause of secondary HTN, and when left undiagnosed, it can make high blood pressure difficult to control, with broad implications for CKD. 

Despite the renal risk, fewer than 1% of hypertensive patients are screened for PA,3 and approximately two-thirds remain unscreened for albuminuria - an early marker of kidney damage and CKD.4 Current guidelines now recommend screening all hypertensive patients for both PA and CKD to support earlier detection, guide targeted treatment, and help reduce the development and progression of diseases like CKD.5,6

1 in 5 people with HTN may have CKD1
Up to 30% of HTN patients have PA5
Patients with PA have a 50% increased risk of CKD7
~14% of CKD patients are tested for PA8 but 39% meet PA criteria9
Download the hypertension insights infographic

Guideline-based testing for Chronic Kidney Disease (CKD) with Kidney Profile

Traditional serum creatinine (eGFR) testing may only reveal one side of the CKD story. For the complete picture, guidelines recommend both the eGFR blood test and the urine albumin-to-creatinine ratio (uACR) test to assess kidney function damage.10

Quest offers a Kidney Profile consisting of these 2 guideline-based tests with a single test code to help diagnose CKD, manage disease progression, establish follow-up testing frequency, and know when referral to a nephrologist is recommended.

Guidelines recommend annual Kidney Profile testing in all patients with3:

  • Diabetes
  • Hypertension
  • Existing CKD
  • Family history of CKD
  • Other risk factors for CKD

1 in 3 adults in the US is at risk for CKD11

9 in 10 adults with CKD don’t know they have it11

Learn more about Kidney Profile

2024 KDIGO clinical practice guidelines include an updated testing algorithm for CKD 

An updated formula for estimating CKD stage combines 2 biomarkers: creatinine and cystatin C. Updated guidance also includes a heatmap for testing frequency and recommended care approach for CKD patients. See how Quest's Kidney Profile portfolio aligns with KDIGO recommendations.
Download CKD testing brochure Kidney Profile test details
Illustration of cardiometabolic organ systems

Primary Aldosteronism (PA) is more common than previously recognized

120M US adults have hypertension1

Up to 30% of people with hypertension seen by specialists have primary aldosteronism5

<1% of patients with hypertension are screened for primary aldosteronism3

PA is a condition that can lead to serious health complications if patients aren’t screened and diagnosed.

Despite its prevalence, PA remains significantly underdiagnosed, particularly in patients with resistant or difficult-to-control hypertension. Identifying PA enables targeted therapy and, when appropriate, timely nephrology referral to help address the underlying cause.

Compared to primary hypertension, untreated PA is associated with a disproportionately higher risk of cardiovascular, kidney, and metabolic complications.12,13

Recent alignment of major society guidelines supports more broad screening for PA

2025 American Heart Association (AHA) and American College of Cardiology (ACC) guidelines for the prevention, detection, evaluation, and management of high blood pressure in adults recommend screening all patients with resistant hypertension6

2025 Endocrine Society clinical practice guidelines on primary aldosteronism suggest that all patients with hypertension be screened5

Looking for more insights on primary aldosteronism screening?

Read our Provider Insights article for more details on updated guidelines and testing strategies.

Read the article

Simplified PA screening solution from Quest Diagnostics

Clinical practice guidelines for PA diagnosis

  • If the result of Plasma Renin Activity (PRA) is suppressed (ie, ≤1 ng/mL/h), and
  • The result of Aldosterone is ≥7.5 ng/mL, and
  • The Aldosterone Renin Ratio (ARR) value is >15

Then, the patient meets criteria for primary aldosteronism based on the 2025 Endocrine Society clinical practice guidelines.5

Plasma Renin Activity (PRA) Reflex to Aldosterone, LC/MS/MS
An ARR >15 confirms the presence of PA. To calculate the ARR, divide the Aldosterone result by the Plasma Renin Activity result.

Read more about primary aldosteronism and Quest's screening solutions

Download brochure
PA brochure thumbnail
Instant insights: Kidney Profile and eGFR with Creatinine & Cystatin C
Instant insights: Rethinking PA diagnosis 
PA: Next steps in care 
Unpacking PA: New insights and advances in diagnosis 

Continue the conversation

Consider testing your patients with hypertension for CKD and PA today. We are here, ready to answer questions so connect with one of our in-house experts to continue the conversation.

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References

1. CDC. High blood pressure facts. January 28, 2025. Accessed May 12, 2026. https://www.cdc.gov/high-blood-pressure/data-research/facts-stats/index.html

2. CDC. Chronic kidney disease among adults with hypertension. CDC Kidney Disease Surveillance System. Accessed May 15, 2026. https://wwwn.cdc.gov/kdss/detail.aspx?Qnum=Q764&topic=4&

3. Funder JW, Carey RM, Fardella C, et al. Case detection, diagnosis, and treatment of patients with primary aldosteronism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2008;93(9):3266–3281. doi: 10.1210/jc.2008-0104

4. Kibbi R, Huang X, Vaishnavi K, et al. Albuminuria prevalence among US adults with cardiovascular-kidney-metabolic syndrome. J Am Heart Assoc. 2026;15(7):e045697. doi:10.1161/JAHA.125.045697

5. Adler GK, Stowasser M, Correa RR, et al. Primary aldosteronism: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2025;110(9):2453-2495. doi: 10.1210/clinem/dgaf284

6. Jones DW, Ferdinand KC, Taler SJ, et al. 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM guideline for the prevention, detection, evaluation and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Hypertension. 2025;82(10):e212-e316. doi:10.1161/HYP.0000000000000249

7. Townsend RR, Agiro A, Luan S, et al. Risk of hypertension and chronic kidney disease following aldosterone dysregulation. Am J Hypertens. 2026;39(1):161-170. doi:10.1093/ajh/hpaf183

8. Chauhan K, Schachna E, Libianto R, et al. Screening for primary aldosteronism is underutilised in patients with chronic kidney disease. J Nephrol. 2022;35(6):1667-1677. doi:10.1007/s40620-022-01267-3

9. Kitlinski M, Dreja K, Heleniak Z, Dębska-Ślizień A. Renal dysfunction in primary aldosteronism: how, when, and who? Kidney Dial. 2025;5(1):3. doi:10.3390/kidneydial5010003

10. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int. 2024; 105 (Suppl 4S):S117-S314. doi:10.1016/j.kint.2023.10.018

11. National Kidney Foundation. Kidney Disease: Fact Sheet. Last updated August 6, 2024. Accessed June 9, 2026. https://www.kidney.org/about/kidney-disease-fact-sheet

12. Cleveland Clinic. Primary aldosteronism (Conn’s syndrome). Last reviewed July 22, 2024. Accessed June 9, 2026. https://.my.clevelandclinic.org/health/diseases/21061-conns-syndrome 

13. Hung A, Ahmed S, Gupta A, et al. Performance of the aldosterone to renin ratio as a screening test for primary aldosteronism. J Clin Endocrinol Metab. 2021;106(8):2423–2435. doi: 10.1210/clinem/dgab348

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