慢性肾脏病全谱中的肾上腺功能储备。

Adrenal functional reserve in the full spectrum of chronic kidney disease.

机构信息

Endocrinology Department.

Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico).

出版信息

Gac Med Mex. 2021;157(5):502-507. doi: 10.24875/GMM.M21000605.

DOI:10.24875/GMM.M21000605

PMID:35104264

Abstract

BACKGROUND

Altered cortisol levels have been associated with an increase in mortality and a decrease in health-related quality of life in patients with chronic kidney disease (CKD); however, adrenal response to adrenocorticotropic hormone (ACTH) stimulation test has not been evaluated in patients with stage 3a to 5 CKD with and without renal replacement therapy (RRT).

OBJECTIVE

To evaluate adrenal function in patients with CKD.

MATERIALS AND METHODS

Adults with CKD underwent a low-dose cosyntropin stimulation test (1 µg synthetic ACTH), with serum cortisol levels being measured at 0, +30 and +60 minutes post-test.

RESULTS

Sixty participants with stage 3, 4 and 5 CKD (with and without RRT) were included. None of the patients had adrenal insufficiency (AI). The correlation observed between cortisol concentration at baseline and 30 minutes and 1 hour after stimulation and glomerular filtration rate (GFR) was negative and statistically significant (r: -0.39 [p = 0.002], r: -0.363 [p = 0.004], r: -0.4 [p = 0.002], respectively).

CONCLUSION

Since CKD early stages, cortisol levels increase as GFR decreases. Therefore, we conclude that systematic screening for AI is not necessary in CKD patients.

摘要

背景

皮质醇水平的改变与慢性肾脏病（CKD）患者的死亡率增加和健康相关生活质量下降有关；然而，在接受和不接受肾替代治疗（RRT）的 3a 期至 5 期 CKD 患者中，尚未评估促肾上腺皮质激素（ACTH）刺激试验的肾上腺反应。

目的

评估 CKD 患者的肾上腺功能。

材料和方法

接受低剂量促皮质素兴奋试验（1μg 合成 ACTH）的 CKD 成年患者，在试验后 0、+30 和+60 分钟测量血清皮质醇水平。

结果

共纳入 60 例 3、4 和 5 期 CKD（有和无 RRT）患者。无一例患者存在肾上腺功能不全（AI）。刺激后基础和 30 分钟及 1 小时皮质醇浓度与肾小球滤过率（GFR）之间存在负相关，且具有统计学意义（r：-0.39 [p = 0.002]，r：-0.363 [p = 0.004]，r：-0.4 [p = 0.002]）。