ArticleEndocrine2025
"Impaired adrenal responsiveness in hemodialysis patients: a low-dose ACTH stimulation test study".
Article in Endocrine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeThe diagnosis of hypocortisolism is challenging in hemodialysis (HD) patients due to shared clinical features between renal failure and cortisol deficiency. We tested the hypothesis that cortisol deficiency due to pituitary-adrenal axis insufficiency is missed a significant percentage of HD patients.
methodsA prospective cohort of 56 end stage kidney disease patients on maintenance HD treatment (mean age 65.3 ± 13.1, females 80%) was studied. Low dose (1 mcg) adrenocorticotropic hormone (ACTH) test was performed on all patients and blood tests for cortisol, ACTH, insulin like growth factor 1 (IGF-1), triiodothyronine (TSH), free thyroxine (FT4), renin and aldosterone, were obtained before hemodialysis session. Adrenal insufficiency was defined as a peak serum cortisol level of < 500 nmol/l at 30–60 min after stimulation.
results14 patients (25%) out of the study population had an abnormal ACTH test. Mean systolic blood pressure in the group with abnormal ACTH test was 135.2 ± 22.0 mm Hg with no difference in blood pressure in multivariable models between the groups with abnormal and normal ACTH test. Neither differences were observed in electrolyte levels, nor in renin/ aldosterone levels between these groups. Baseline ACTH level predicted an abnormal ACTH test in the study population in both, univariate and multivariate analyses. For each 1 pg/ml increase in baseline ACTH concentration the odds for abnormal ACTH test was 1.15 (95% CI: 1.03 to 1.29). In addition, IGF-SDS (standard deviation score) higher than − 0.04 significantly decreased odds for hypocortisolism (OR 0.14, 95% CI: 0.02 to 0.81) in multivaiable logistic regression models.
conclusionsRoutine evaluation of the hypothalamic-pituitary-adrenal axis (HPA) in symptomatic HD patients can reveal adrenal insufficiency, even without classic clinical signs. The 1 µg ACTH test, alongside IGF-1 SDS and baseline ACTH levels, may assist in identifying patients at risk and support timely and life-saving intervention during acute clinical deterioration.
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