{"id":"bb744356ec2b","type":"article","url":"https://hartvaat.nl/2026/09/01/hydrocortison-verhoogt-sterfte-en-cardiorenale-uitkomsten-bij-ckd-met-septische-/","title":"Hydrocortison verhoogt sterfte en cardiorenale uitkomsten bij CKD met septische shock","title_en":"Hydrocortisone Use for Septic Shock in Patients With CKD.","category":"chronische nierziekte","category_label":"Nierziekte","professions":["cardioloog","internist"],"tags":[],"journal":"Kidney international reports","doi":"10.1016/j.ekir.2026.106686","source_url":"https://doi.org/10.1016/j.ekir.2026.106686","authors":["Parth Dhamelia","Hashane Abeyagunawardene","Rajshekhar A Kore","Deepa Raghavan","John M Arthur","Keyur Vyas","Ninad Khandekar","Nishank Jain"],"significance":5,"published":"2026-08-02","source_date":"2026-09-01","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/"],"congress":"","summary_en":"In a large propensity-matched cohort of 26,282 patients with nondialysis CKD and septic shock, hydrocortisone use was associated with higher 90-day mortality (HR 1.31), major adverse kidney events (HR 1.08), and major adverse cardiovascular events (HR 1.19). While reinfection rates were slightly lower, there were no significant differences in hyperglycemia or delirium. These observational findings highlight potential cardiorenal and survival risks with hydrocortisone in CKD patients with sepsis, underscoring the need for rigorous randomized trials to guide therapy in this high-risk population.","created":"2026-07-27T00:45:39Z","updated":"2026-08-10T10:37:30Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"In een groot retrospectief cohort van 26.282 patiënten met niet-dialyse-CKD en septische shock was het gebruik van hydrocortison geassocieerd met een verhoogd risico op 90-dagen sterfte (HR 1,31), cardiorenale complicaties (MAKE HR 1,08) en cardiovasculaire events (MACCE HR 1,19). Hoewel het risico op herinfecties iets lager was, waren er geen significante verschillen in hyperglykemie of delirium. Deze bevindingen uit een grote claimsdatabase onderstrepen de noodzaak van gerandomiseerde studies om de veiligheid en effectiviteit van hydrocortison bij deze kwetsbare groep te bevestigen.","abstract_original":"INTRODUCTION: Patients with chronic kidney disease (CKD) are at higher risk of septic shock and mortality than the general population. Although hydrocortisone is often used as an adjuvant therapy for septic shock in the general population to improve clinical outcomes, its effectiveness in patients with CKD remains understudied. METHODS: We identified a retrospective cohort of patients within TriNetX US collaborative database diagnosed with nondialysis CKD between November 1, 2010 and October 31, 2025 who also developed septic shock. Outcomes of interest within 90 days included all-cause mortality, major adverse kidney events (MAKE) without persistent kidney dysfunction, major adverse cardiovascular or cerebrovascular events (MACCE), mechanical ventilation, hyperglycemia, reinfections, and delirium. Survival analyses and multivariable Cox proportional hazard models were performed. RESULTS: One to 1, we propensity-score matched 13,141 CKD patients with sepsis treated with hydrocortisone with 13,141 CKD patients with sepsis not treated with hydrocortisone. Our cohort had a mean age of 70 ± 12 years and was 46% female, 21% African American, and 5% Hispanic. Most patients had hypertension (95%), were diabetic (63%), and had ischemic heart disease (68%). Mean serum creatinine concentration was 2.3 ± 2.7 mg/dl, mean lactate concentration was 3 mmol/l, and 25% of patients required mechanical ventilation. In this propensity-score matched analysis, more patients died in the group given hydrocortisone than in the group not given hydrocortisone (4263 [32.4%] vs. 3654 [27.8%]) with adjusted hazard ratio (HR) 1.31 (95% confidence interval [CI]: 1.25-1.36). Hydrocortisone group had higher risk of MAKE HR 1.08 (95% CI: 1.05-1.12), MACCE HR 1.19 (95% CI: 1.15-1.24), and mechanical ventilation HR 1.34 (95% CI: 1.27-1.41) but lower reinfections HR 0.88 (95% CI: 0.85-0.91) and no differences in hyperglycemia HR 1.04 (95% CI: 1.00-1.07) and delirium HR 1.07 (95% CI: 1.00-1.14). CONCLUSION: In this large, national, multicenter retrospective cohort of patients with CKD and septic shock, use of hydrocortisone was associated with increased risk of mortality, cardiorenal, and pulmonary outcomes, but reduced risk of reinfections. These findings warrant more research to rigorously evaluate the effects of hydrocortisone use in septic shock for this high-risk population."}