CHARACTERISTICS OF ADRENAL INSUFFICIENCY IN PATIENTS UNDERGOING HEMODIALYSIS FOR END-STAGE KIDNEY FAILURE

Background: Adrenal insufficiency causes nonspecific symptoms such as general fatigue, signs such as hypotension, and abnormalities such as hypoglycemia and leads to a poor prognosis. However, all these are also observed in hemodialysis (HD) patients without adrenal insufficiency. This study aims to investigate the prevalence and clinical characteristics of adrenal insufficiency in patients undergoing hemodialysis due to end-stage kidney failure. Aims: This study was performed to clarify the characteristics of adrenal insufficiency in hemodialysis patients. Methods. Between January-June 2020, 243 patients aged ≥18 years who underwent hemodialysis treatment in Karabuk Training and Research Hospital were evaluated. Among these patients, 137 patients who were sent to the endocrine outpatient clinic with a pre-diagnosis of possible adrenal insufficiency were included in the study. Based on baseline cortisol levels and results of the low-dose 1 μg ACTH stimulation test, patients were categorized as having or not having adrenal insufficiency. Parametric data among the groups were compared with Student T-test and non-parametric data were compared with Mann-Whitney U-test. Chi-square test was used to compare categorical data between both groups. Multivariate logistic regression analysis was also used. Results. Eight HD patients were diagnosed with adrenal insufficiency. There was no significant difference between groups in age, gender, BMI, dialysis duration, or Ca×P. However, patients with adrenal insufficiency had significantly lower Kt/V values (median 1.35 vs. 1.5, p = 0.018). A Kt/V value below 1.35 can be considered an independent predictor of adrenal insufficiency (OR: 59.5, 95% CI: 1.402–2524, p = 0.033). Conclusions. Adrenal insufficiency should be considered in hemodialysis patients presenting with non-specific symptoms such as nausea, vomiting, hypotension, and fatigue. A Kt/V value below 1.35 may serve as an independent predictor of adrenal insufficiency in this population.