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Adrenal functional reserve in the full spectrum of chronic kidney disease

René Rodríguez-Gutiérrez1,2, José G González-González1,2, Alberto Martínez-Rodríguez3

  • 1Endocrinology Department.

Gaceta Medica De Mexico
|February 1, 2022
PubMed

Insights

Cortisol levels rise in early chronic kidney disease (CKD) as kidney function declines. This study found no adrenal insufficiency (AI) in CKD patients, suggesting routine AI screening is unnecessary.

Area of Science:

  • Endocrinology
  • Nephrology
  • Internal Medicine

Background:

  • Altered cortisol levels are linked to mortality and reduced quality of life in chronic kidney disease (CKD) patients.
  • Adrenal response to adrenocorticotropic hormone (ACTH) stimulation has not been well-evaluated in stages 3-5 CKD, with or without renal replacement therapy (RRT).

Purpose of the Study:

  • To evaluate adrenal function in patients diagnosed with chronic kidney disease (CKD).

Main Methods:

  • A low-dose cosyntropin (synthetic ACTH) stimulation test was administered to adult CKD patients.
  • Serum cortisol levels were measured at baseline, 30 minutes, and 60 minutes post-stimulation.

Main Results:

  • Sixty participants with stages 3-5 CKD (with/without RRT) were included; none exhibited adrenal insufficiency (AI).
  • A significant negative correlation was found between glomerular filtration rate (GFR) and cortisol levels at baseline, 30 minutes, and 60 minutes post-ACTH stimulation (r: -0.39 to -0.4, p ≤ 0.004).

Conclusions:

  • Cortisol levels increase in early CKD stages as GFR decreases.
  • Systematic screening for adrenal insufficiency (AI) is not deemed necessary for patients with chronic kidney disease (CKD).
Abstract

Keywords:
Adrenal insufficiency Chronic kidney diseaseCortisolEnfermedad renal crónicaInsuficiencia adrenal

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