Department of Endocrinology, Diabetes & Metabolism, Kantonsspital Aarau, Aarau, Switzerland.
Departments of General Internal and Emergency Medicine, Medical University Clinic, Kantonsspital Aarau, Tellstrasse H7, CH-5001, Aarau, Switzerland.
BMC Nephrol. 2021 Nov 1;22(1):360. doi: 10.1186/s12882-021-02541-5.
Secondary adrenal insufficiency is a frequent issue in patients with renal replacement therapy. There are concerns about metabolism and clearance for adrenocorticotropic hormone (ACTH) and cortisol in addition to hemoconcentration as confounding factors during hemodialysis (HD). Therefore, ACTH testing is currently performed before or in between HD sessions. This review of the literature aims to evaluate the current evidence for validity of testing for adrenal insufficiency in patients on chronic renal replacement therapy.
A literature search of PubMed database for interventional and observational clinical trials was performed. Case reports and reviews were excluded. The search included all articles published until July 2020.
Of 218 potentially eligible articles, 16 studies involving 381 participants were included. Seven studies performed an ACTH test before HD or in between HD sessions. There was no data available regarding ACTH testing during HD. But there was evidence of decreased cortisol levels during HD as compared to afterwards. All included 16 studies measured basal cortisol, and seven studies performed an ACTH test. Seven trials had comparable data of baseline cortisol for a quantitative analysis. Standardized mean difference of overall cortisol was 0.18 nmol/l (95%CI - 0.08 to 0.44) in the case group.
In patients undergoing renal replacement therapy, basal serum cortisol values are comparable to healthy volunteers. There is limited data on the validity of stimulated cortisol in these patients, especially during HD.
Registration no. CRD42020199245 .
继发性肾上腺功能不全是接受肾脏替代治疗患者的常见问题。除了血液浓缩这一混杂因素外，促肾上腺皮质激素（ACTH）和皮质醇的代谢和清除也受到关注。因此，目前在血液透析（HD）前后进行 ACTH 检测。本文旨在评估目前关于慢性肾脏替代治疗患者肾上腺功能不全检测的有效性的证据。
对 PubMed 数据库中的干预和观察性临床试验进行文献检索。排除病例报告和综述。搜索包括截至 2020 年 7 月发表的所有文章。
在 218 篇潜在合格的文章中，纳入了 16 项研究，共涉及 381 名参与者。有 7 项研究在 HD 前后进行了 ACTH 检测。但没有关于 HD 期间进行 ACTH 检测的数据。但有证据表明，与 HD 后相比，HD 期间皮质醇水平降低。所有纳入的 16 项研究均测量了基础皮质醇，并进行了 7 项 ACTH 检测。有 7 项试验具有可进行定量分析的皮质醇基线的可比数据。总的皮质醇的标准化均数差值为 0.18 nmol/l（95%CI -0.08 至 0.44）。
在接受肾脏替代治疗的患者中，基础血清皮质醇值与健康志愿者相当。目前关于这些患者刺激皮质醇的有效性的数据有限，尤其是在 HD 期间。
注册号 CRD42020199245。
