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Adrenocortical function in hypotensive patients with end stage renal disease
Alejandro L Arregger1, Estela M L Cardoso2, Alfredo Zucchini3
1Endocrine Research Department, Instituto de Investigaciones Médicas A.Lanari, University of Buenos Aires, Argentina.
Steroids
|April 2, 2014
Summary
Adrenal insufficiency is common in end-stage renal disease patients on dialysis (ESRDh). Assessing adrenal function, particularly cortisol and aldosterone levels, is crucial for diagnosing and treating these conditions, improving patient outcomes.
Area of Science:
- Endocrinology
- Nephrology
- Clinical Medicine
Background:
- Sustained hypotension affects 5.0%–12.0% of patients with end-stage renal disease on dialysis (ESRDh).
- The role of corticoadrenal hormones in blood pressure regulation in ESRDh is under-investigated.
Purpose of the Study:
- To detect adrenal insufficiency in ESRDh.
- To follow the clinical outcomes of ESRDh with adrenal insufficiency.
Main Methods:
- Studied 50 ESRDh and 30 healthy volunteers.
- Measured basal and ACTH-stimulated serum and salivary cortisol and aldosterone.
- Assessed circulating ACTH and renin levels.
Main Results:
- Identified primary adrenal insufficiency (4), secondary adrenal insufficiency (6), selective hypoaldosteronism (9), and secondary hyperaldosteronism (16) in ESRDh.
- Established cut-off values for basal serum and salivary cortisol and aldosterone to predict adrenal insufficiency and hyperaldosteronism with high sensitivity and specificity.
- Patients with adrenal insufficiency improved clinically and normalized blood pressure with steroid therapy.
Conclusions:
- Adrenal function screening is essential in ESRDh.
- Early detection and treatment of adrenal insufficiency can improve clinical outcomes and blood pressure control in ESRDh.
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