Suspected adrenal insufficiency in hemodialysis patients with recurrent intradialytic hypotension.

Authors

Noha Mohamed Elkholy, Mohammad Elraggal, Merna AbouKhatwa, Marwa Ahmed Salah Ahmed

Published in

International urology and nephrology. Jul 27, 2026. Epub Jul 27, 2026.

Abstract

Intradialytic hypotension (IDH) is a frequent complication of maintenance hemodialysis and is associated with increased morbidity. The role of adrenal insufficiency (AI) as a potential contributor to recurrent IDH remains insufficiently characterized.
To evaluate the prevalence of adrenal insufficiency among hemodialysis patients with recurrent intradialytic hypotension and to examine associated clinical and biochemical characteristics.
In this cross-sectional study, adult patients undergoing maintenance hemodialysis who experienced recurrent intradialytic hypotension were recruited from a tertiary dialysis center. Morning serum cortisol and plasma adrenocorticotropic hormone (ACTH) were measured prior to dialysis. Patients were classified as having suspected adrenal insufficiency if their serum cortisol levels were less than 18 μg/dL. Clinical and laboratory parameters were compared between adrenal insufficient and adrenal-sufficient patients.
Fifty-one hemodialysis patients with recurrent intradialytic hypotension were evaluated. The mean age was 52.35 ± 13.6 years, and 37.2% were male. Adrenal insufficiency was identified in 37 patients (72.5%). Based on basal ACTH levels, 4 patients (7.8%) were classified as suspected primary AI and 33 (64.7%) as suspected secondary AI. No significant differences were observed between groups regarding age, sex, dialysis vintage, or interdialytic weight gain. Adrenal insufficient patients demonstrated significantly lower serum sodium and random blood glucose levels and higher serum potassium levels compared with adrenal-sufficient patients (p < 0.05).
Adrenal insufficiency was frequently detected among hemodialysis patients with recurrent intradialytic hypotension in this single-center cohort. Biochemical findings were compatible with impaired adrenal function. Further studies are required to validate diagnostic thresholds in this population and to determine the therapeutic implications of identifying adrenal dysfunction in patients with intradialytic hypotension.

PMID:
42507289
Bibliographic data and abstract were imported from PubMed on 27 Jul 2026.

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