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Adrenal Insufficiency in Dialysis Patients
Stéphane Roueff1, Hélène Lazareth1,2, Julien Riancho2,3,4
1Nephrology Department, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
Seminars in Dialysis
|July 31, 2025
Summary
Adrenal insufficiency (AI) is uncommon in dialysis patients, but may affect up to 20% of those with chronic hypotension. Diagnosis is challenging due to nonspecific symptoms and potential dialysis-related cortisol fluctuations.
Area of Science:
- Nephrology
- Endocrinology
Background:
- Chronic kidney disease and dialysis impact adrenal function with conflicting data.
- End-stage renal disease patients risk hypercortisolism due to disrupted cortisol cycles.
- Dialysis may influence cortisol synthesis, with recent data linking dialysis vintage to adrenal insufficiency.
Purpose of the Study:
- To review the pathophysiology, diagnosis, and etiology of adrenal insufficiency in dialysis patients.
- To clarify the unknown prevalence and diagnostic challenges of AI in this population.
Main Methods:
- Literature review summarizing existing data on adrenal function in dialysis patients.
- Discussion of diagnostic approaches including ACTH stimulation tests and salivary cortisol measurements.
- Identification of clinical situations suggestive of AI in dialysis patients.
Main Results:
- Adrenal insufficiency (AI) is considered uncommon in dialysis patients, though prevalence is unknown.
- Some studies suggest AI may affect up to 20% of chronically hypotensive dialysis patients.
- AI diagnosis is difficult due to nonspecific symptoms that can be masked by dialysis.
Conclusions:
- Adrenal function is generally preserved in dialysis patients, with AI being rare but challenging to diagnose.
- Delayed diagnosis is common, often occurring during adrenal crisis.
- Specific diagnostic criteria and suggestive clinical signs are crucial for identifying AI in dialysis patients.
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