Effect of Thyroid Hormones on Kidney Function in Patients after Kidney Transplantation

Abstract

Elevated levels of thyroid-stimulating-hormone (TSH) are associated with reduced glomerular filtration rate (GFR) and increased risk of developing chronic kidney disease even in euthyroid patients. Thyroid hormone replacement therapy has been shown to delay progression to end-stage renal disease in sub-clinically hypothyroid patients with renal insufficiency. However, such associations after kidney transplantation were never investigated. In this study the association of thyroid hormones and estimated GFR (eGFR) in euthyroid patients after kidney transplantation was analyzed. In total 398 kidney transplant recipients were assessed retrospectively and association between thyroid and kidney function parameters at and between defined time points, 12 and 24 months after transplantation, was studied. A significant inverse association was shown for TSH changes and eGFR over time between months 12 and 24 post transplantation. For each increase of TSH by 1 µIU/mL, eGFR decreased by 1.34 mL/min [95% CI, −2.51 to −0.16; p = 0.03], corresponding to 2.2% eGFR decline, within 12 months. At selected time points 12 and 24 months post transplantation, however, TSH was not associated with eGFR. In conclusion, an increase in TSH between 12 and 24 months after kidney transplantation leads to a significant decrease in eGFR, which strengthens the concept of a kidneythyroid-axis.

Thyroid Feedback Quantile-based Index correlates strongly to renal function in euthyroid individuals

“…The correlation between thyroid function and renal function remains a relevant topic as a consensus has not been reached despite much discussion in the literature from the past five years. Our results on the negative relationship between TSH and renal function were consistent with several previous findings [ 9 , 11 , 14 ]. This observation is also supported by a study on urine albumin excretion that found higher TSH (even in the euthyroid range) was associated with a higher risk of microalbuminuria [ 10 ].…”

Is there a relationship between the prevalence of autoimmune thyroid disease and diabetic kidney disease?

“…In patients with CKD, most commonly, decreased concentration of T3 is observed, which is associated with a decrease in the peripheral T4 to T3 conversion. Chronic metabolic acidosis associated with CKD may contribute to this [ 31 , 32 ]. Zoccali et al observed that low fT3 concentration is common in inflammatory diseases and in CKD and ESRD patients and also observed that fT3 is acutely and reversibly inhibited in CKD patients during inflammatory processes caused by coexisting infections [ 33 ].…”

Assessment of decrease in renal function associated with hypothyroidism

“…Effective hormone replacement therapy has been shown to postponed the progression to end-stage renal disease in sub-clinically hypothyroid patients with renal insufficiency. In a study conducted by Scharier he concluded that the an increase in TSH between 12 and 24 months after kidney transplantation leads to a significant decrease in eGFR, which strengthens the concept of a kidney-thyroid-axis [21].…”