Hamana Clinic, 235-1 Numa, Hamakita-ku, Hamamatsu, Shizuoka, 434-0037, Japan.
Internal Medicine 1, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
Clin Exp Nephrol. 2022 Sep;26(9):933-941. doi: 10.1007/s10157-022-02230-z. Epub 2022 May 21.
Adrenal insufficiency in hemodialysis patients is commonly encountered in clinical practice. However, its association with end-stage renal disease is unclear. We investigated the relationship between adrenal function and relevant clinical parameters, focusing on dialysis vintage.
Altogether, 100 maintenance hemodialysis patients were enrolled (age: 69.8 ± 11.8 years, dialysis vintage: 9.4 ± 9.2 years). Basal serum cortisol levels were measured and their associations with relevant clinical parameters were investigated. Subsequently, hormone stimulation tests were performed to assess adrenal function.
Basal serum cortisol significantly decreased with an increase in dialysis vintage (< 10 years, 11.9 ± 3.7 μg/dL; 10-19 years, 10.9 ± 2.9 μg/dL; ≥ 20 years, 9.7 ± 3.8 μg/dL). Basal cortisol was negatively correlated with dry weight, β2-microglobulin, creatinine, and lymphocyte count and positively correlated with brachial-ankle pulse wave velocity. Significant negative correlations were observed between basal cortisol and dialysis vintage after adjusting for confounding variables in the multivariate analysis. Standard adrenocorticotropic hormone (ACTH) and corticotropin-releasing hormone (CRH) stimulation tests were performed in 17 patients. Seven patients were diagnosed with adrenal insufficiency and all of them had a long dialysis vintage (≥ 10 years). According to the rapid ACTH test, cortisol responses were significantly decreased in patients with long dialysis vintage compared to those with short dialysis vintage (< 10 years). Similar findings were observed in ten patients without adrenal insufficiency. The CRH loading test showed similar tendencies, although the differences were not statistically significant.
Adrenal function decreased with an increase in dialysis vintage. Long-term dialysis patients might be susceptible to adrenal insufficiency.
在临床实践中，血液透析患者常发生肾上腺功能不全。然而，其与终末期肾病的关系尚不清楚。我们研究了肾上腺功能与相关临床参数之间的关系，重点关注透析龄。
共纳入 100 例维持性血液透析患者（年龄：69.8±11.8 岁，透析龄：9.4±9.2 年）。测量基础血清皮质醇水平，并探讨其与相关临床参数的关系。随后进行激素刺激试验以评估肾上腺功能。
基础血清皮质醇随透析龄的增加而显著降低（<10 年，11.9±3.7μg/dL；10-19 年，10.9±2.9μg/dL；≥20 年，9.7±3.8μg/dL）。基础皮质醇与干体重、β2-微球蛋白、肌酐和淋巴细胞计数呈负相关，与肱踝脉搏波速度呈正相关。在多元分析中调整混杂因素后，基础皮质醇与透析龄呈显著负相关。对 17 例患者进行标准促肾上腺皮质激素（ACTH）和促肾上腺皮质激素释放激素（CRH）刺激试验。7 例患者被诊断为肾上腺功能不全，且均有较长的透析龄（≥10 年）。与透析龄较短的患者（<10 年）相比，长透析龄患者的快速 ACTH 试验中皮质醇反应明显降低。在无肾上腺功能不全的 10 例患者中也观察到类似的发现。CRH 负荷试验也显示出类似的趋势，尽管差异无统计学意义。
随着透析龄的增加，肾上腺功能下降。长期透析患者可能易患肾上腺功能不全。
