Aldosterone and systemic lupus erythematosus what's the full story — ASN Events
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Aldosterone and systemic lupus erythematosus what's the full story (#394)

Charlotte L Uniacke 1 2 , Muhammad Akram 2 , Peter Fuller 1 3 , Maureen Rischmueller 4 5 6 7 , Pravin Hissaria 8 , Sachin Khetan 6 9 , Stephen Brady 7 , Alberta Hoi 3 10 , Eric Morand 3 10 , Jun Yang 2 3 , Fabien Vincent 3 10
  1. Department of Molecular and Translational Science, Monash University, Clayton, Victoria, Australia
  2. Centre for Endocrinology and Reproductive Health, Hudson Institute of Medical Research, Clayton, Victoria, Australia
  3. Department of Medicine, Monash University, Clayton, Victoria, Australia
  4. Rheumatology Department, The Queen Elizabeth Hospital, Woodville, South Australia , Australia
  5. College of Health , Adelaide University , Adelaide , South Australia , Australia
  6. Rheumatology Department, Royal Darwin Hospital , Tiwi, Northern Territory, Australia
  7. Rheumatology Department, Alice Springs Hospital , The Gap , Northern Territory, Australia
  8. Clinical Immunology and Allergy, Royal Adelaide Hospital , Adelaide , South Australia , Australia
  9. College of Medicine and Public Health , Flinders University , Adelaide , South Australia , Australia
  10. Monash Health Lupus Clinic , Monash Health , Clayton , Victoria , Australia

Background: Systemic lupus erythematosus (SLE) carries a high burden of hypertension and cardiovascular disease [1]. Aldosterone excess is a known contributor to cardiovascular risk in the general population [2, 3], and limited evidence of increased incidence of autoimmune disease in an aldosterone excess disease context has been reported [4].

Aims: To characterise aldosterone levels in patients with SLE and explore associations between aldosterone with blood pressure and SLE phenotypes and outcomes

Methods: Serum aldosterone was measured by liquid chromatography-tandem mass spectrometry assay in 314 patients with SLE attending the Monash Health Lupus Clinic (Melbourne, Australia) and 134 healthy controls (HC) between August 2017 and January 2025. Patient clinical data was obtained from the Australian Lupus Registry and Biobank. Associations between aldosterone and clinical characteristics were assessed using quartile-based analyses and continuous aldosterone models with linear and multivariate logistic regression.

Results: 301 SLE patients (mean [SD] age 49.6 [14.7] years, 90.0% female, 48.1% Asian and 34.6% European ethnicity) and 132 HC (mean [SD] age 35.0 [12.6] years, 59.8% female, 47.7% Asian and 38.6% European ethnicity) were analysed, with a median (IQR) follow up period of 9.3 (9.6) years and encompassing 107 (35.6%) patients on ≥1 antihypertensive medications. Across all analyses, serum aldosterone was not significantly different between SLE and HC groups, and was not significantly associated with blood pressure, disease activity, organ involvement, or markers of systemic immune activation. Sex-stratified, log-transformed linear regression demonstrated no differences in blood pressure across aldosterone quartiles. Similarly, aldosterone concentration as a continuous variable was not associated with disease characteristics in multivariable regression analyses.

Conclusion: Aldosterone alone does not appear to be a determinant of SLE clinical phenotypes. Future studies should incorporate renin and the aldosterone-to-renin ratio to assess the relationship between renin-independent aldosterone excess with SLE phenotypes and outcomes.

  1. 1. Munguia-Realpozo, P., et al., Systemic lupus erythematosus and hypertension. Autoimmunity Reviews, 2019. 18(10): p. 102371.
  2. 2. Ananda, R.A., T.A. Mori, and J. Yang, Aldosterone and Cardiovascular Risk Across the Lifespan. Metabolites, 2025. 15(8).
  3. 3. Monticone, S., et al., Cardiovascular events and target organ damage in primary aldosteronism compared with essential hypertension: a systematic review and meta-analysis. Lancet Diabetes Endocrinol, 2018. 6(1): p. 41–50.
  4. 4. Feng, G.S., et al., Primary aldosteronism: an unsuspected culprit of hypertension in systemic lupus erythematosus? Clin Exp Rheumatol, 2023. 41(11): p. 2312–2322.