Prevalence of Subclinical Hypothyroidism in Patients with End-Stage Renal Disease and the Role of Serum Albumin: A Cross-Sectional Study from South India

Abstract

Background/Aim: Subclinical hypothyroidism (SCH) and end-stage renal disease (ESRD) are independent risk factors for cardiovascular mortality. We aimed to study the prevalence of SCH in ESRD patients and assessed its associated risk factors. Methods: This cross-sectional study was conducted at 2 tertiary-care centers in Chennai, India, over a 3-year period. The study group comprised 137 patients with ESRD on thrice weekly regular maintenance hemodialysis. Free thyroxine (FT₄) and thyroid-stimulating hormone (TSH) were measured using an electrochemiluminescence immunoassay. SCH was defined as TSH ranging between 4.5 and 10 mIU/l with normal FT₄ (0.93–1.7 ng/dl). Patients with overt hypothyroidism, SCH and overt hyperthyroidism, those on medications affecting thyroid function and pregnant women were excluded from the study. Results: Of 137 ESRD patients (mean age: 43 ± 13.38 years), 107 were males (78.1%), 45 diabetics (32.8%), 127 hypertensives (92.7%), and 38 smokers (27.7%). Prevalence of SCH was 24.8%. In unadjusted (OR: 3.37, 95% CI: 1.91–5.21) and adjusted (for age, gender, HbA_1C, and albumin/creatinine ratio; OR: 3.11, 95% CI: 2.15–4.98) logistic regression analysis, serum albumin was significantly associated with SCH. Further, multiple linear regression identified that for every 1 g/dl drop in serum albumin TSH increased by 4.61 mIU/l (95% CI: 2.75–5.92). Conclusion: We observed a high prevalence of SCH in our ESRD patients. Also, serum albumin was significantly associated with SCH in our study.

Thyroid dysfunction in patients of chronic kidney disease

“…A similar study was conducted by Shantha et al, where they found the prevalence of SCH was 24.8%. 6 The present study showed that the prevalence of SCH was 25%, which was more in females (52%) as compared to males (48%). This is in contrast to the study of Shantha et al, which showed prevalence of disease was higher in males (73.5%) as compared to females (26.5%) out of 137 ESRD patients.…”

“…This is in contrast to the study of Shantha et al, which showed prevalence of disease was higher in males (73.5%) as compared to females (26.5%) out of 137 ESRD patients. 6 This study has shown a decreased level of serum albumin to be a risk factor for SCH in ESRD patients. Our patients with SCH had significantly lower serum albumin levels compared to patients with normal TSH.…”

Thyroid dysfunctions in patients with chronic renal failure

“…8 In a study by Santha GPS et al reported the prevalence of SCH in ESRD to be 24.8% in Indian Population with a study size of 137 patients with ESRD. 2 In a study by Lim VS the prevalence of SCH in ESRD was 0-9.5%.…”

“…1 For ESRD, the estimated prevalence in India is 200 million per inhabitant. 2 Thyroid hormones (TH) have an important role in regulating metabolism, development of the kidney, maintenance of water and electrolyte homeostasis, protein synthesis and influencing other hormone function. Tri-iodothyronine (T3) and Thyroxin (T4) are the two main hormones produced by the thyroid.…”

Thyroid Status and Mortality in a Prospective Hemodialysis Cohort

“…isorders of thyroid function are an exceedingly common endocrine complication in patients with chronic kidney disease, including those receiving dialysis (1)(2)(3)(4)(5)(6)(7). Data from the Third National Health and Nutrition Examination Survey have shown an increasing burden of hypothyroidism with incrementally impaired kidney function, such that participants with an estimated glomerular filtration rate (eGFR) of ,45 mL/min/1.73 m had a nearly fivefold higher prevalence compared with those with an eGFR $90 mL/min/1.73 m 2 (;23% vs ;5%, respectively) (2).…”