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Hydrocortisone Use for Septic Shock in Patients With CKD
Parth Dhamelia1, Hashane Abeyagunawardene1, Rajshekhar A Kore1
1Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Kidney International Reports
|July 25, 2026
Summary
Hydrocortisone use in chronic kidney disease (CKD) patients with septic shock increased mortality and adverse outcomes. This study suggests caution when using hydrocortisone in this high-risk population.
Area of Science:
- Nephrology
- Critical Care Medicine
- Pharmacology
Background:
- Patients with chronic kidney disease (CKD) face elevated risks for septic shock and mortality.
- Hydrocortisone is a common adjuvant therapy for septic shock, but its efficacy in CKD patients is not well-established.
Purpose of the Study:
- To evaluate the effectiveness and safety of hydrocortisone as an adjuvant therapy for septic shock in patients with non-dialysis CKD.
Main Methods:
- A retrospective cohort study was conducted using the TriNetX US collaborative database.
- 13,141 CKD patients with septic shock treated with hydrocortisone were propensity-score matched with 13,141 CKD patients with septic shock not treated with hydrocortisone.
- Outcomes including mortality, major adverse kidney events (MAKE), major adverse cardiovascular or cerebrovascular events (MACCE), mechanical ventilation, hyperglycemia, reinfections, and delirium were assessed within 90 days.
Main Results:
- Hydrocortisone use was associated with increased all-cause mortality (adjusted hazard ratio [HR]: 1.31; 95% CI: 1.25-1.36).
- Higher risks of MAKE (HR: 1.08), MACCE (HR: 1.19), and mechanical ventilation (HR: 1.34) were observed in the hydrocortisone group.
- The hydrocortisone group showed a reduced risk of reinfections (HR: 0.88).
Conclusions:
- In patients with CKD and septic shock, hydrocortisone administration correlated with heightened risks of mortality, cardiorenal, and pulmonary complications.
- Conversely, hydrocortisone use was linked to a decreased incidence of reinfections.
- Further research is essential to thoroughly investigate the impact of hydrocortisone in septic shock management for this vulnerable patient group.
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