Association between adrenal function and dialysis vintage in hemodialysis patients,Clinical and Experimental Nephrology

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Association between adrenal function and dialysis vintage in hemodialysis patients
Clinical and Experimental Nephrology ( IF 2.2 ) Pub Date : 2022-05-21 , DOI: 10.1007/s10157-022-02230-z
Yukitoshi Sakao _{1,

2} , Naro Ohashi ₂ , Taichi Sato ₂ , Sayaka Ishigaki ₃ , Shinsuke Isobe ₂ , Tomoyuki Fujikura ₂ , Akihiko Kato ₃ , Hideo Yasuda ₂

Affiliation

Introduction

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.

Methods

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.

Results

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.

Conclusions

Adrenal function decreased with an increase in dialysis vintage. Long-term dialysis patients might be susceptible to adrenal insufficiency.

中文翻译：

血液透析患者肾上腺功能与透析时间的关系

介绍

血液透析患者的肾上腺功能不全在临床实践中很常见。然而，其与终末期肾病的关系尚不清楚。我们调查了肾上腺功能与相关临床参数之间的关系，重点是透析年份。

方法

总共招募了 100 名维持性血液透析患者（年龄：69.8 ± 11.8 岁，透析年龄：9.4 ± 9.2 岁）。测量了基础血清皮质醇水平，并研究了它们与相关临床参数的关系。随后，进行激素刺激测试以评估肾上腺功能。

结果

随着透析年份的增加，基础血清皮质醇显着下降（< 10 岁，11.9 ± 3.7 μg/dL；10-19 岁，10.9 ± 2.9 μg/dL；≥ 20 岁，9.7 ± 3.8 μg/dL）。基础皮质醇与干重、β2-微球蛋白、肌酐和淋巴细胞计数呈负相关，与臂踝脉搏波速度呈正相关。在多变量分析中调整混杂变量后，观察到基础皮质醇和透析年份之间存在显着的负相关。对 17 名患者进行了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 名患者被诊断为肾上腺功能不全，所有患者的透析时间都较长（≥ 10 年）。根据快速ACTH测试，与透析时间短（< 10 年）的患者相比，长期透析患者的皮质醇反应显着降低。在没有肾上腺功能不全的 10 名患者中观察到类似的结果。CRH 负荷试验显示出相似的趋势，但差异无统计学意义。