Thyroid function tests in acute kidney injury

Iglesias, Pedro; Olea, Teresa; Vega-Cabrera, Cristina; Heras, Manuel; Bajo, María Auxiliadora; Peso, Gloria del; Arias, M. Jerez; Selgas, Rafael; Díez, Juan J.

doi:10.5301/jn.5000106

Cited by 21 publications

(15 citation statements)

References 39 publications

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“…The relationship between low T3 syndrome or thyroid dysfunction and AKI has been reported previously [17,18], yet the relationship between low FT3 and CI-AKI has rarely been investigated. In this study we found that a serum FT3<3.1 pmol/L was an independent risk factor of CI-AKI, as well as a predictor of long-term mortality after pPCI.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have also suggested that thyroid function disorders including low FT3 are correlated to AKI. In a prospective study by Iglesias P et al [17] which enrolled 35 consecutive patients with AKI, alteration in thyroid function tests was detected in over 80% of these patients and the most common disorder was low T3 syndrome. However, due to its short follow-up period and small sample size, this study failed to determine the prognostic value of thyroid function tests for AKI.…”

Section: Discussionmentioning

confidence: 99%

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Negative association between free triiodothyronine level and contrast-induced acute kidney injury in patients undergoing primary percutaneous coronary intervention

et al. 2019

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Background: A low FT3 level is significantly associated with a variety of kidney disease and acute myocardial infarction (AMI). However, it remains unclear whether low FT3 is associated with CI-AKI in patients who underwent pPCI. Methods: Single-center retrospective study evaluated 363 STEMI patients undergoing pPCI. Patients were classfied into 2 groups, low FT3 group (FT3 < 3.1 pmol/L) and normal FT3 group (FT3 ≥ 3.1 pmol/L);CI-AKI was defined as an increase in the serum creatinine levels of ≥50% or 0.3 mg/dL above the baseline level within 48 h after contrast medium exposure. Results: Overall, 80(22.0%) patients had low FT3, and 59(16.3%) patients developed CI-AKI. The incidence of CI-AKI and in-hospital mortality was significantly higher in patients with low FT3 than normal (31.3% vs 12.0%; 15.0% vs 3.2%, respectively, both p < 0.0001). Multivariate logistic regression analysis indicated that low FT3 was an independent predictor of CI-AKI (odds ratio [OR] = 2.62, 95%CI:1.35-5.07, p < 0.05). In addition, low FT3 was associated with an increased risk of all-cause mortality during a mean follow-up period of 20 months (hazard ratio [HR] = 2.54, 95%CI:1.15-5. 60, p < 0.05). Conclusion: Low FT3 was associated with CI-AKI, short-and long-term mortality in STEMI patients after pPCI.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Negative association between free triiodothyronine level and contrast-induced acute kidney injury in patients undergoing primary percutaneous coronary intervention

et al. 2019

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“…In contrast to T4 which is largely produced by the thyroid gland, 80% of T3 is produced by peripheral deiodination of T4 to T3 [46]. Low T3 levels were also the most commonly observed thyroid functional test alteration observed in a recent study of 35 patients with acute kidney injury (37.1% of patients) [49]. Deiodination is decreased in uremia, nonthyroidal illness, starvation, inflammation, certain medications (e.g.…”

Section: Triiodothyroninementioning

confidence: 98%

Thyroid functional disease: an under-recognized cardiovascular risk factor in kidney disease patients

Rhee¹,

Brent²,

Kövesdy³

et al. 2014

Nephrology Dialysis Transplantation

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Thyroid functional disease, and in particular hypothyroidism, is highly prevalent among chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients. In the general population, hypothyroidism is associated with impaired cardiac contractility, endothelial dysfunction, atherosclerosis and possibly higher cardiovascular mortality. It has been hypothesized that hypothyroidism is an under-recognized, modifiable risk factor for the enormous burden of cardiovascular disease and death in CKD and ESRD, but this has been difficult to test due to the challenge of accurate thyroid functional assessment in uremia. Low thyroid hormone levels (i.e. triiodothyronine) have been associated with adverse cardiovascular sequelae in CKD and ESRD patients, but these metrics are confounded by malnutrition, inflammation and comorbid states, and hence may signify nonthyroidal illness (i.e. thyroid functional test derangements associated with underlying ill health in the absence of thyroid pathology). Thyrotropin is considered a sensitive and specific thyroid function measure that may more accurately classify hypothyroidism, but few studies have examined the clinical significance of thyrotropin-defined hypothyroidism in CKD and ESRD. Of even greater uncertainty are the risks and benefits of thyroid hormone replacement, which bear a narrow therapeutic-to-toxic window and are frequently prescribed to CKD and ESRD patients. In this review, we discuss mechanisms by which hypothyroidism adversely affects cardiovascular health; examine the prognostic implications of hypothyroidism, thyroid hormone alterations and exogenous thyroid hormone replacement in CKD and ESRD; and identify areas of uncertainty related to the interplay between hypothyroidism, cardiovascular disease and kidney disease requiring further investigation.

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“…It was previously reported that patients with critical illness were predisposed to thyroid function derangement, of which low T3 syndrome was the most common [30, 31]. Although the presence of thyroid dysfunction seemed not to be associated with the clinical and prognostic implication of AKI in previous report [34], some other studies documented that Cys C concentration was sensitive to small change of thyroid hormones. Therefore, alterations of thyroid function should be considered when Cys C is used for AKI detection in critically ill patients [16–18].…”

Section: Discussionmentioning

confidence: 97%

Impact of thyroid function on cystatin C in detecting acute kidney injury: a prospective, observational study

Zhang

Gao

Ye³

et al. 2019

BMC Nephrol

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BackgroundCystatin C (Cys C) used clinically for detecting early acute kidney injury (AKI) was reported to be associated with thyroid function. Therefore, whether the performance of Cys C is affected by thyroid hormones has raised concern in critically ill patients. This study aimed to investigate the impact of thyroid hormones on the diagnostic and predictive accuracy of Cys C for AKI, and hence optimize the clinical application of Cys C.MethodsA prospective observational study was conducted in the general intensive care units (ICUs). Serum creatinine (SCr), Cys C, and thyroid function were documented for all patients at ICU admission. Patients were separated into five quintiles based on free triiodothyronine (FT3) and total triiodothyronine (TT3), and two categories according to the presence of low T3 syndrome or not. The impact of thyroid function on the performance of Cys C in diagnosing and predicting AKI was assessed by area under the receiver operating characteristic curve (AUC).ResultsThe AKI incidence was 30.0% (402/1339); 225 patients had AKI upon entry, and 177 patients developed AKI during the subsequent 7 days. The AUCs for Cys C in detecting total AKI, established AKI, and later-onset AKI was 0.753, 0.797, and 0.669, respectively. The multiple linear regression analysis demonstrated that TT3 and FT3 were independently associated with Cys C. Overall, although Cys C did not yield any significant difference in AUCs for detecting AKI among patients with different thyroid hormones, the optimal cut-off value of Cys C to detect AKI was markedly different between patients with and without low T3 syndrome.ConclusionsThe thyroid function had no significant impact on the diagnostic and predictive accuracy of Cys C in detecting AKI in ICU patients. However, the optimal cut-off value of Cys C to detect AKI could be affected by thyroid function.Electronic supplementary materialThe online version of this article (10.1186/s12882-019-1201-9) contains supplementary material, which is available to authorized users.

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Thyroid function tests in acute kidney injury

Cited by 21 publications

References 39 publications

Negative association between free triiodothyronine level and contrast-induced acute kidney injury in patients undergoing primary percutaneous coronary intervention

Negative association between free triiodothyronine level and contrast-induced acute kidney injury in patients undergoing primary percutaneous coronary intervention

Thyroid functional disease: an under-recognized cardiovascular risk factor in kidney disease patients

Impact of thyroid function on cystatin C in detecting acute kidney injury: a prospective, observational study

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