Cortisolverlust und Plasma-11-Hydroxy-Corticosteroidprofil während der Hämodialyse

Deck, K. A.; Siemon, G; Sieberth, H. G.; Bayer, H. von

doi:10.1007/978-3-642-47083-7_300

Cited by 3 publications

(6 citation statements)

References 7 publications

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“…Deck e f al. [19] showed a decrease of 50% of the initial values of plasma corticoid metabolites during haemodialysis that we confirmed indirectly by detecting 50% of normal urinary excretion in the dialysis fluids and Savard [21] found also these metabolites in haemodialysate.…”

Section: Discussionsupporting

confidence: 73%

“…In CRF the half-life of cortisol is prolonged [16] and its metabolism delayed [18, 191. In reduced glomerular filtration rate (GFR) the conjugated corticoid metabolites cannot be removed entirely and were found to be accumulated in the blood plasma [18,19]. In CRF the half-life of cortisol is prolonged [16] and its metabolism delayed [18, 191. In reduced glomerular filtration rate (GFR) the conjugated corticoid metabolites cannot be removed entirely and were found to be accumulated in the blood plasma [18,19].…”

Section: Discussionmentioning

confidence: 99%

“…Plasma cortisol levels are usually normal in dialysed patients, but occasionally increased [16, 171. In CRF the half-life of cortisol is prolonged [16] and its metabolism delayed [18, 191. In reduced glomerular filtration rate (GFR) the conjugated corticoid metabolites cannot be removed entirely and were found to be accumulated in the blood plasma [18,19]. Englert et al…”

Section: Discussionmentioning

confidence: 99%

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Neutral steroid metabolites in patients with uraemia and after renal transplantation: a quantitative and qualitative study in body fluids

Ludwig-Köhn

Henning

Sziedat

et al. 1985

Eur J Clin Investigation

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Steroid metabolites enriched from urine, haemofiltrate, and CAPD-dialysate (Continuous Ambulatory Peritoneal Dialysis) were identified by gas chromatography-mass spectrometry and quantified by capillary gas chromatography. The study included twenty healthy controls, twenty-six non-dialysed uraemics, thirty-nine patients on regular dialysis treatment, and twenty-two allograft recipients. Compared to the 24 h urinary excretion rates of controls the excretion rates of androsterone and etiocholanolone were in the lower normal range up to significantly decreased in the body fluids of all patients, and those of the corticoid metabolites were also significantly decreased. 11-Oxygenated androstanolones in urine from non-dialysed uraemics correlated significantly decreased. 11-oxygenated androstano-levels and were significantly increased, but normal in haemofiltrate and CAPD-dialysate, while in urine of allograft recipients the values were significantly lower.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Neutral steroid metabolites in patients with uraemia and after renal transplantation: a quantitative and qualitative study in body fluids

Ludwig-Köhn

Henning

Sziedat

et al. 1985

Eur J Clin Investigation

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“…This is not due t o an increased ratio of free/bound cortisol, but probably to decreased inhbition of cortisol metabolism by its own metabolites. An increased plasma clearance of cortisol would explain the rather consistent finding [8,9,161, that plasma 11-OHCS levels or plasma cortisol levels decrease faster during the first 30-60 min of dialysis than during comparable times on control days in spite of wide variations in plasma cortisol levels during the rest of the dialysis period in different persons. Lowering of plasma cortisol during dialysis might lead to negative feedback stimulation of cortisol secretion; studying plasma cortisol levels during dialysis therefore might yield more information about the function of this regulatory system [8, 10, 171.…”

Section: Discussionmentioning

confidence: 99%

Studies on cortisol metabolism during haemodialysis in man

Deck

Fischer

Hillen

1979

Eur J Clin Investigation

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Plasma clearance rates and dialysance of labelled cortisol were measured in patients on chronic intermittent dialysis during and after dialysis. Plasma clearance rates during dialysis were 30--63% higher than after dialysis; dialysance was 0.3--0.7 1/h and accounted only for 20--35% of the increase of plasma clearance rates during dialysis. After bolus injection of labelled cortisol, disappearance curves were obtained in two normal subjects and two uraemic subjects on and off dialysis. Biological halftimes of the different segments of the disappearance curves and distribution volumes were calculated. The size of the inner compartment (V1) is greater in uraemia. The disappearance curves flatten after the end of dialysis, indicating an increase of biological halftime after dialysis. Plasma 17-OHCS-glucuronides dropped from 2.13 +/- 0.62 micromol/l (n = 20) at the beginning to 1.05 +/- 0.65 micromol/l at the end of dialysis and increased to 1.51 +/- 0.43 micromol/l (n = 12) within 3 h thereafter. During dialysis cortisol metabolites are removed from the blood. This may decrease inhibition of cortisol metabolism by the end products of cortisol metabolism which might explain the more rapid plasma clearance and the shortened cortisol half-life during haemodialysis.

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“…There are concerns about metabolism and clearance for adrenocorticotropic hormone and cortisol in addition to hemoconcentration due to removal of plasma water (ultrafiltration) as a confounding factor during HD. Some [ 16 – 18 ], but not all studies [ 19 ], report that free plasma cortisol is transferred into the dialysate during HD, which leads to a decrease in plasma cortisol concentration. Due to these concerns, the ACTH test is routinely performed before or between HD sessions.…”

Section: Introductionmentioning

confidence: 99%

Adrenal function testing in dialysis patients – a review of the literature

et al. 2021

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Background Secondary adrenal insufficiency is a frequent issue in patients with renal replacement therapy. There are concerns about metabolism and clearance for adrenocorticotropic hormone (ACTH) and cortisol in addition to hemoconcentration as confounding factors during hemodialysis (HD). Therefore, ACTH testing is currently performed before or in between HD sessions. 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. Methods A literature search of PubMed database for interventional and observational clinical trials was performed. Case reports and reviews were excluded. The search included all articles published until July 2020. Results Of 218 potentially eligible articles, 16 studies involving 381 participants were included. Seven studies performed an ACTH test before HD or in between HD sessions. There was no data available regarding ACTH testing during HD. But there was evidence of decreased cortisol levels during HD as compared to afterwards. All included 16 studies measured basal cortisol, and seven studies performed an ACTH test. Seven trials had comparable data of baseline cortisol for a quantitative analysis. Standardized mean difference of overall cortisol was 0.18 nmol/l (95%CI − 0.08 to 0.44) in the case group. Conclusions In patients undergoing renal replacement therapy, basal serum cortisol values are comparable to healthy volunteers. There is limited data on the validity of stimulated cortisol in these patients, especially during HD. Trial registration Registration no. CRD42020199245.

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Cortisolverlust und Plasma-11-Hydroxy-Corticosteroidprofil während der Hämodialyse

Cited by 3 publications

References 7 publications

Neutral steroid metabolites in patients with uraemia and after renal transplantation: a quantitative and qualitative study in body fluids

Neutral steroid metabolites in patients with uraemia and after renal transplantation: a quantitative and qualitative study in body fluids

Studies on cortisol metabolism during haemodialysis in man

Adrenal function testing in dialysis patients – a review of the literature

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