Abnormal Thyroid‐Stimulating Hormone and Chronic Kidney Disease in Elderly Adults in Taipei City

Abstract

OBJECTIVES:To examine whether older people with abnormal thyroid function are more likely to develop chronic kidney disease (CKD) over a 5-year follow-up period. DESIGN: Retrospective cohort study. SETTING: Health examination data from the Taipei Databank for Public Health Analysis. PARTICIPANTS: Individuals aged 65 and older (N = 41,454). MEASUREMENTS: Thyroid-stimulating hormone (TSH) levels were repeatedly measured, and subjects were categorized into four thyroid function groups (hyperthyroid, euthyroid, subclinical hypothyroid, overt hypothyroid). The risk of incident CKD was evaluated using a stepwise Cox proportional hazards regression model adjusted for sex, baseline age, hypertension, diabetes mellitus (DM), dyslipidemia, hyperuricemia, anemia, obesity, liver function, smoking, and alcohol. RESULTS: Higher TSH levels were associated with greater risk of subsequent CKD. Individuals with subclinical hypothyroidism (hazard ratio (HR) = 1.15, 95% confidence interval (CI) = 1.05-1.26) and those with overt hypothyroidism (HR = 1.27, 95% CI = 1.04-1.55) were more likely than those who were euthyroid to have CKD. Women were more likely to have CKD than men (HR = 1.11, 95% CI = 1.06-1.16). When stratified by gender, subclinical hypothyroidism in women was associated with an increased risk of developing CKD (HR = 1.22; 95% CI = 1.08-1.39). When stratified by DM, subclinical hypothyroidism and overt hypothyroidism were associated with an increased risk of developing CKD in nondiabetics (HR = 1.19; 95% CI = 1.07-1.31; and HR = 1.34; 95% CI = 1.08-1.65, respectively). CONCLUSION: This cohort study of elderly persons in Taipei City found a significant association between hypothyroidism and development of CKD in women and individuals without DM.

Relationship between Thyroid and Kidney Function: Analysis from the Korea National Health and Nutrition Examination Survey Between 2013 and 2015

“…eGFR, estimated glomerular filtration rate; ACME, average causal mediation effect; ADE, average direct effect; fT4, free thyroxine. not heavily considered when determining if treatment is necessary for SCH; however, numerous studies have revealed that SCH may cause a decline in kidney function [20][21][22][23][24]30]. If small changes in the thyroid hormone levels, which are within the reference range, have negative effects on the kidney health, earlier replacement of thyroid hormone may prevent the progression of CKD in SCH patients [30].…”

“…Experimental studies have suggested that a deficiency in thyroid hormones may reduce the glomerular filtration rate [18] by reducing cardiac output, renal plasma flow, and sodium resorption [19]. To date, many studies have suggested that SCH was associated with reduced kidney function [20][21][22][23][24]. Some have even reported that an elevated TSH level, but within the reference range, was associated with chronic kidney disease (CKD) [25][26][27].…”

Anemia in thyroid diseases

“…Both these conditions may have an additive deteriorating effect on hemoglobin levels and increase the risk of anemia. 86 Su et al 87 found that the response to therapy with erythropoiesis-stimulating agents is not satisfactory in patients with subclinical hypothyroidism who are on dialysis due to chronic kidney disease. The dose of erythropoietin that needs to be used to treat anemia in such patients is significantly higher compared with that in euthyroid patients with renal function impairment, and the response to therapy improves following L-thyroxine administration.…”

Association of TSH Elevation with All-Cause Mortality in Elderly Patients with Chronic Kidney Disease

“…Aging, hypertension, diabetes, and cardiovascular disease (CVD) are important determinants of CKD [2], but some cases of CKD are of unknown etiology [2, 3]. A recent epidemiological study found a significant relationship between elevated thyroid-stimulating hormone (TSH) level and the development of CKD in elderly persons [4]. Other studies have shown that TSH level increases with aging in the general population [5, 6, 7, 8, 9], and hypothyroidism is prevalent among CKD patients [10, 11, 12].…”