In patients undergoing renal replacement therapy, basal serum cortisol values are comparable to healthy volunteers. Standardized mean difference of overall cortisol was 0.18 nmol/l (95%CI − 0.08 to 0.44) in the case group. Seven trials had comparable data of baseline cortisol for a quantitative analysis. All included 16 studies measured basal cortisol, and seven studies performed an ACTH test. But there was evidence of decreased cortisol levels during HD as compared to afterwards. There was no data available regarding ACTH testing during HD. Seven studies performed an ACTH test before HD or in between HD sessions. Of 218 potentially eligible articles, 16 studies involving 381 participants were included. The search included all articles published until July 2020. MethodsĪ literature search of PubMed database for interventional and observational clinical trials was performed. 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. Therefore, ACTH testing is currently performed before or in between HD sessions. There are concerns about metabolism and clearance for adrenocorticotropic hormone (ACTH) and cortisol in addition to hemoconcentration as confounding factors during hemodialysis (HD). Secondary adrenal insufficiency is a frequent issue in patients with renal replacement therapy.
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