The following is a summary of “Performance of synacthen test in chronic hemodialysis patients,” published in the November 2023 issue of Nephrology by Nickler et al.
Chronic hemodialysis (HD) patients typically undergo Synacthen tests when not receiving hemodialysis treatment. Researchers initiated a retrospective study to evaluate the equivalence of serum cortisol concentrations pre- and during hemodialysis for standard-dose (250 µg) and low-dose (1 µg) Synacthen tests.
They performed Synacthen tests in four different scenarios, both in standard and low doses, before and during HD. Cortisol levels were measured at specific intervals post-Synacthen administration (30 and 60 minutes, and 20 minutes in the low-dose test). Log-scale cortisol concentration means were estimated for each dose and test time combination using a multivariable linear mixed model. Mean differences were computed and tested for equivalence using the TOST method, which confirmed if the 90% CI of the cortisol mean difference lay between -0.22 and 0.22.
The results showed equivalence in serum cortisol concentrations at 30 and 60 minutes post Synacthen administration in both standard and low doses for 28 chronic HD patients before and during HD. Among 56 low-dose tests, in 10 instances, the peak cortisol was reached after 20 minutes. However, cortisol levels at 20 and 30 minutes post the low-dose Synacthen test, both before and during HD, did not show a significant difference.
Investigators concluded that conducting adrenal function tests during hemodialysis appeared to be a convenient and feasible practice.
Source: bmcnephrol.biomedcentral.com/articles/10.1186/s12882-023-03347-3
