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Gaceta médica de México

versão On-line ISSN 2696-1288versão impressa ISSN 0016-3813

Resumo

RODRIGUEZ-GUTIERREZ, René et al. Adrenal functional reserve in the full spectrum of chronic kidney disease. Gac. Méd. Méx [online]. 2021, vol.157, n.5, pp.519-524.  Epub 13-Dez-2021. ISSN 2696-1288.  https://doi.org/10.24875/gmm.21000441.

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.

Palavras-chave : Cortisol; Adrenal insufficiency; Chronic kidney disease.

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