Association between hypothyroidism and chronic kidney disease observed among an adult population 55 years and older

Abstract

Hypothyroidism and chronic kidney disease (CKD) are highly prevalent conditions with a potential mechanistic link. We sought to determine whether hypothyroidism is associated with CKD among a large diverse community-based cohort. A cross-sectional study was performed (January 1, 1990–December 31, 2017) within a large integrated health system. Individuals age ≥55 years of age with outpatient measurements of thyroid stimulating hormone (TSH) and ≥2 serum creatinine values were included. Hypothyroidism was defined as TSH >4 mIU/L and/or receipt of thyroid hormone replacement and further categorized as hypothyroid status: TSH >4 mcIU/mL and attenuated-hypothyroid status: TSH <4 mcIU/mL with receipt of thyroid hormone replacement. Euthyroidism was defined as TSH <4 mIU/L and no thyroid hormone replacement. Our primary measure was CKD defined as an estimated glomerular filtration rate (eGFR) <45 mL/min/1.73 m2. Multivariable logistic regression adjusting for age, sex, race, and comorbidities was used to estimate odds ratios (OR) for CKD by thyroid status. Among 378,101 individuals, 114,872 (30.4%) had hypothyroidism among whom 31,242 and 83,630 had hypothyroid and attenuated-hypothyroid statuses, respectively. Individuals with hypothyroidism had a CKD OR (95%CI) of 1.25 (1.21–1.29) compared with those with euthyroidism. Granular examination of thyroid statuses showed that hypothyroid and attenuated-hypothyroid statuses had CKD ORs (95% CI) of 1.59 (1.52–1.66) and 1.12 (1.08–1.16), respectively. A similar relationship was observed in analyses that defined CKD as an eGFR <60 L/min/1.73 m2. Among individuals 55 years and older, we observed that those with hypothyroidism were more likely to have CKD. A stronger association was found among patients of hypothyroid status compared with attenuated-hypothyroid status suggesting a dose dependent relationship.

Thyroid Function and Reduced Kidney Function with Aging in Chinese Older Adults: A Cross- sectional Study

“…Besides, A study from the Netherlands showed similar result in older population (age ≧ 85years) [10]. Conversely, some studies based on the general population demonstrated that TSH was not associated with risk of incident reduced kidney function [17,20,24]. The differences in race, age and included correction factors may result in these con icting results.…”

“…Indexes of thyroid function vary with aging, thus the association of thyroid function and declining kidney function in older adults was different from this in the young and remains controversial [5]. Previous studies demonstrated that thyroid dysfunction was associated with estimated GFR (eGFR) and likelihood of prevalent CKD [6,17]. No data to date investigate the association between normal thyroid function and reduced kidney function with aging in general Chinese older population.…”

Thyroid disorders in adult patients with chronic renal failure

“…En Misiones, Argentina, la frecuencia de hipotiroidismo subclínico en IRC fue 28,3 % (1) . En Brasil, el hipotiroidismo en sujetos en hemodiálisis fue 21,8 % (16) , 24 % en Rumania (17) , 20 % en Italia (18) y 30 % en Estados Unidos (19) . En Nepal, en una serie de pacientes adultos con IRC se detectaron variados casos de disfunción tiroidea: hipotiroidismo subclínico (27 %), hipotiroidismo clínico (8 %) e hipertiroidismo subclínico (3 %) (20) .…”

“…Este tema debería investigarse más a fondo, con un enfoque nutricional. Entre las debilidades de esta investigación se deben mencionar: no se practicó ecografía tiroidea, la determinación de anticuerpos antitiroideos se realizó sólo en aquellos sujetos con hipotiroidismo, no se realizó una evaluación longitudinal de la función tiroidea (19) . Se recomienda un seguimiento evolutivo de los pacientes con IRC y trastornos tiroideos debido a que se estima un deterioro más rápido de la función renal con valores de TSH aumentados, incluyendo a aquellos que aún se hallan en fase predialítica (22,28) .…”

“…Si bien el diagnóstico del hipotiroidismo es simple y el tratamiento es rentable y seguro, no existen fuertes recomendaciones con respecto a su detección rutinaria en pacientes con IRC (19) . Pero basados en los hallazgos del estudio, se recomienda el tamizaje de las enfermedades tiroideas en este tipo de pacientes de otros centros hospitalarios y su seguimiento evolutivo.…”