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

Abstract

Chronic kidney disease (CKD) is a widespread condition in the global population and is more common in the elderly. Thyroid-stimulating hormone (TSH) level increases with aging, and hypothyroidism is highly prevalent in CKD patients. However, the relationship between low thyroid function and mortality in CKD patients is unclear. Therefore, we conducted a retrospective cohort study to examine the relationship between TSH elevation and all-cause mortality in elderly patients with CKD. This retrospective cohort study included individuals ≥65 years old with CKD (n = 23,786) in Taipei City. Health examination data from 2005 to 2010 were provided by the Taipei Databank for Public Health Analysis. Subjects were categorized according to thyroid-stimulating hormone (TSH) level as follows: low normal (0.34<TSH<1.074 mIU/L), middle normal (1.074≤TSH≤2.46 mIU/L), high normal (2.46<TSH<5.2 mIU/L), elevated I (5.2≤TSH<10 mIU/L), and elevated II (TSH≥10 mIU/L). Risk of mortality was evaluated using a Cox proportional hazard regression model adjusted for sex, age, hypertension, diabetes mellitus, CKD stage, serum albumin, high-density lipoprotein cholesterol, uric acid, hemoglobin, body mass index, glutamic-pyruvic transaminase, smoking, alcohol consumption, and history of cardiovascular disease (coronary artery disease, congestive heart failure, cerebral vascular disease), history of cancer, and history of chronic obstructive pulmonary disease. Our results showed that compared to the reference group (middle normal TSH), the risk of all-cause mortality was increased in the elevated I group (hazard ratio [HR], 1.21; 95% confidence interval [CI], 1.02–1.45) and elevated II group (HR, 1.30; 95% CI, 1.00–1.69). We found a significant association between TSH elevation and all-cause mortality in this cohort of elderly persons with CKD. However, determining the benefit of treatment for moderately elevated TSH level (5.2–10 mIU/L) in elderly patients with CKD will require a well-designed randomized controlled trial.

Thyroid hormones and diabetic nephropathy: An essential relationship to recognize

“…The present results in DN patients suggest that high TSH levels should be regulated, especially those with TSH levels of 4.54–5.67 μIU/L. This was partly consistent with a study of 23 786 elderly CKD patients, which determined that moderately elevated TSH (TSH ≥5.2– < 10 mIU/L) was significantly associated with all‐cause mortality . Another study suggested that controlling TSH levels at <3.0 μIU/L in normal range could decreased the rate of CKD in patients with T2DM .…”

“…This was partly consistent with a study of 23 786 elderly CKD patients, which determined that moderately elevated TSH (TSH ≥5.2-<10 mIU/L) was significantly associated with all-cause mortality. 43 Another study suggested that controlling TSH levels at <3.0 μIU/L in normal range could decreased the rate of CKD in patients with T2DM. 44 As shown in our study, it was suggested FT3 being maintained at a high level in normal range to reduce renal damage in DN.…”

Hypothyroidism and chronic kidney disease: An undervalued two-way relationship

“…In CKD patients, hypothyroidism, even subclinical, is linked to accelerated GFR decline and increased mortality 5,[59][60][61][62] . Hormonal replacement therapy can potentially reduce GFR decline 63,64 .…”

TSH Elevation and Chronic Kidney Disease in Elderly Adults

“…Thyroidstimulating hormone (TSH) progressively increases over time in older individuals, and hypothyroidism is highly prevalent in CKD patients. Hypothyroidism was reported to be associated with increased mortality in CKD patients [1,2]. The hypothesis of an adaptive and protective effect of abnormal thyroid function in CKD patients has been suggested [3].…”

“…For elderly patients with CKD, the author also observed an increased death risk in individuals with TSH level higher than 5.2 mIU/L. It is also important for health care providers to acknowledge that periodic evaluation of TSH level in elderly CKD patients might be helpful to detect abnormal thyroid function [2]. However, a welldesigned randomized controlled trial is needed to evaluate the benefit of treating TSH elevation in elderly patients with CKD.…”