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Mounting evidence suggests that milder forms of renin-independent aldosterone production (subclinical primary aldosteronism) are highly prevalent; however, the link between subclinical primary aldosteronism and eGFR decline remains unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prospective cohort study included 976 Canadian adults aged 40\u201369 years, with predominantly normal BP or mild untreated hypertension, from the randomly sampled, population-based CARTaGENE cohort. Aldosterone and renin concentrations were measured at enrollment (2009\u20132010). Creatinine and cystatin C were measured at enrollment and 5\u20137 years postenrollment. Multivariable linear mixed regression models were used to measure the associations of aldosterone, renin, and the aldosterone-to-renin ratio (ARR) with eGFR decline over time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The mean (SD) age of participants was 53 (7) years; 51% were female. Mean BP was 121 (15)\/72 (10) mm Hg, and 11% had BP \u2265140\/90 mm Hg. Mean eGFR\n                      <jats:sub>CrCysC<\/jats:sub>\n                      was 109 (16) ml\/min per 1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      . At higher ARR levels, there was steeper mean eGFR decline over time (Tertile 1 [ARR, \u22640.49 ng\/dl per mU\/L]: \u22121.40 [1.77] ml\/min per 1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      \/yr, Tertile 2 [ARR, 0.50\u20130.87 ng\/dl per mU\/L]: \u22121.48 [1.75] ml\/min per 1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      \/yr, Tertile 3 [ARR, &gt;0.87 ng\/dl per mU\/L]: \u22121.57 [1.79] ml\/min per 1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      \/yr;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.01), representing 11% steeper decline in the highest versus lowest ARR tertile. At lower renin levels, there was steeper mean eGFR decline over time (Tertile 1 [renin, \u22649.2 mU\/L]: \u22121.59 [1.80] ml\/min per 1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      \/yr, Tertile 2 [renin, 9.3\u201315.9 mU\/L]: \u22121.53 [1.77] ml\/min per 1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      \/yr, Tertile 3 [renin, &gt;15.9 mU\/L]: \u22121.33 [1.72] ml\/min per 1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      \/yr;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.04), representing 16% steeper eGFR decline in the lowest versus highest renin tertile. There was no significant association between aldosterone and eGFR change over time (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.50). All aforementioned associations were independent of BP and were consistent among participants with normal BP in isolation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Independent of BP, elevated ARR and suppressed renin were associated with steeper eGFR decline over time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Podcast<\/jats:title>\n                    <jats:p>This article contains a podcast at https:\/\/dts.podtrac.com\/redirect.mp3\/www.asn-online.org\/media\/podcast\/JASN\/2026_04_30_ASN0000001039.mp3<\/jats:p>\n                  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