Front Endocrinol (Lausanne). 2026 Sep 15;17:1916237. doi: 10.3389/fendo.2026.1916237. eCollection 2026.
ABSTRACT
INTRODUCTION: To characterize electrolyte and renal-metabolic profiles in primary aldosteronism (PA) compared with essential hypertension (EH), and to examine differences between unilateral/lateralizing and bilateral PA.
METHODS: PubMed, Embase, the Cochrane Library, and Web of Science were searched from inception through 13 July 2026. Random-effects meta-analyses pooled standardized mean differences (SMD; Hedges' g), supplemented by clinical-unit mean-difference analyses, subgroup analyses, sensitivity analyses, and study-level meta-regression.
RESULTS: A total of 74 observational studies involving 26,143 participants were included. Compared with hypertensive controls, PA was associated with lower serum potassium (SMD = -1.15, 95% CI -1.27 to -1.02), higher serum sodium (SMD = 0.51, 95% CI 0.38 to 0.63), and lower uric acid (SMD = -0.23, 95% CI -0.35 to -0.12), whereas creatinine, estimated glomerular filtration rate (eGFR), and blood urea nitrogen (BUN) did not differ significantly. Corresponding PA-minus-control mean differences were -0.49 mmol/L for potassium, +1.20 mmol/L for sodium, and -20.7 μmol/L for uric acid. Potassium was lower in unilateral/lateralizing than in bilateral PA (SMD = -0.85). The potassium difference versus controls was greater in studies with high plasma aldosterone concentration (PAC) than in those with low PAC (SMD -1.44 vs. -1.03; p for subgroup difference = 0.010), although continuous PAC meta-regression was not significant. UACR/ACR and urinary albumin excretion were higher in PA (SMD = 0.49 and 0.73).
DISCUSSION: PA shows a persistent electrolyte phenotype and higher albuminuria despite similar cross-sectional filtration markers. These findings support renal assessment with UACR alongside routine filtration measures and reinforce that PA screening should not depend on overt hypokalemia alone.
SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420261286832.
PMID:42812167 | PMC:PMC13619399 | DOI:10.3389/fendo.2026.1916237