Unresolved Subclinical Hypothyroidism is Independently Associated with Progression of Chronic Kidney Disease

Kim, Eun Oh; Lee, Ihn Suk; Choi, Yoo A; Lee, Sang Ju; Chang, Yoon Kyung; Yoon, Hye Eun; Jang, Yi Sun; Lee, Jong Min; Kim, Hye Soo; Yang, Chul Woo; Kim, Suk Young; Hwang, Hyeon Seok

doi:10.7150/ijms.7186

Cited by 15 publications

(13 citation statements)

References 24 publications

(25 reference statements)

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“…8 It is frequently seen in patients with chronic kidney disease/failure. 9 Also, with the decrease in glomerular filtration rate the prevalence of subclinical hypothyroidism increases. In the United States the prevalence of subclinical hypothyroidism is 4-8.5%.…”

Section: Introductionmentioning

confidence: 99%

Thyroid dysfunctions in patients with chronic renal failure

et al. 2017

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Background: Chronic renal failure (CRF), or end-stage renal disease (ESRD), is a progressive, irreversible deterioration in renal function in which the body’s ability to maintain metabolic and fluid and electrolyte balance fails, resulting in the development of clinical symptoms like uraemia or azotemia. Thyroid hormones 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. The patients with chronic renal failure often exhibit clinical features and laboratory findings which are indicative of thyroid dysfunction, since, kidney is involved in the metabolism and elimination of TH.Methods: This was a cross sectional single centre descriptive study, including 50 patients of either gender between the age of 45-70 years.Results: Present study found a significant positive correlation between the TSH levels and Zulewski score in patients with CRF.Conclusions: Since there was found to be a correlation between the TSH levels and Zulewski score, the evaluation of symptoms and signs with Zulewski score in addition to thyroid function testing in patients with thyroid dysfunction is essential, since it can be a marker for CRF.

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Section: Introductionmentioning

confidence: 99%

Thyroid dysfunctions in patients with chronic renal failure

et al. 2017

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“…Thyroid hormones influence kidney function by direct renal effects as well as systemic hemodynamic [ 16 ], metabolic, and cardiovascular effects [ 17 ]. Previous studies showed that overt and subclinical hypothyroidisms were associated with reduced eGFR and increased risk of CKD and unresolved subclinical hypothyroidism were independently associated with the rate of renal function decline [ 12 ], and thyroid hormone supplement attenuated the alterations [ 18 – 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…Overt thyroid disease is relatively uncommon in T2D, and only a few studies investigated their relationship with kidney function in T2D. Some studies have shown that overt and subclinical hypothyroidisms were associated with reduced eGFR and increased risk of CKD [ 8 – 11 ] and that unresolved subclinical hypothyroidism was independently associated with the rate of renal function decline [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Relationship between Thyroid Function and Kidney Function in Patients with Type 2 Diabetes

Zhang

Wang²,

Tao

et al. 2018

International Journal of Endocrinology

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Purpose To determine if the TSH is related to estimated glomerular filtration rate (eGFR) in T2D patients without overt thyroid dysfunction. Methods A cohort study of 5936 T2D patients was assessed for thyroid and kidney functions, in whom 248 with subclinical hyperthyroidism and 362 with subclinical hypothyroidism. Serum creatinine and 24-hour urine albumin excretion (UAE) were collected. Chronic kidney disease (CKD) was defined as eGFR < 60 ml/min/1.73 m2. Results Compared with euthyroid subjects, the patients with subclinical hypothyroidism had lower eGFR (82.7 ± 22.4 vs. 90.5 ± 22.4 ml/min/1.73 m2, p < 0.01), higher UAE (114 ± 278 vs. 88 ± 229 mg/24 h, p < 0.05), and high incidence of CKD (16.0% vs. 10.1%, p < 0.05). The participants with a TSH level between 0.55 and 3.0 μIU/ml had a higher eGFR (91.4 ± 22.2 ml/min/1.73 m2) and a lower prevalence of CKD (9.5%) than those with higher TSH (3.01–4.78 μIU/ml, 85.6 ± 22.7 ml/min/1.73 m2, p < 0.01 and 13.1%, p < 0.01). Linear logistic regression analysis showed that the eGFR was significantly negatively associated with TSH (OR: 0.519, 95% CI: 0.291–0.927, p < 0.05), after adjustment of confounders. Conclusion High TSH was independently associated with decreased eGFR in type 2 diabetes patients without overt thyroid dysfunction. Our findings indicate that doctors who treat T2D patients should routinely measure the thyroid function.

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“…Hypothyroidism diminishes protein synthesis and cellular development, which leads to decreases in cell number, density, and size of the kidney [3]. It has been demonstrated that subclinical hypothyroidism might be a risk factor for faster decline of renal function [4][5][6], with possible effect on recovery or preservation of renal function with treatment [7,8]. However, this finding are controversial and the effect of low free thyroxine (LFT) levels on eGFR decline in CKD patients has not been thoroughly investigated.…”

Section: Introductionmentioning

confidence: 99%

Influence of low free thyroxine on progression of chronic kidney disease

et al. 2020

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Background: Hypothyroidism is highly prevalent in patients with chronic kidney disease (CKD) and has been associated with poorer clinical outcomes, including faster decline of kidney function. However, there is no consensus whether low free thyroxin (LFT) affects the rate of estimated glomerular filtration rate (eGFR) decline and how the presence of proteinuria influences the progression of renal dysfunction in hypothyroidism. Methods: We assessed thyroid status, proteinuria, and progression of eGFR by Modification of Diet in Renal Disease equation and CKD-EPI equation in a cohort of CKD patients followed in general nephrology clinics. We estimated the association of LFT levels, and the degree of proteinuria on progression of eGFR. We adjusted for other covariables: age, gender, body mass index, diabetes, hypertension, HbA1c, uric acid, cholesterol, and triglycerides levels.. Results: One thousand six hundred ten patients (64 ± 15 years, 46.8% men, 25.3% diabetic) were included. At beggnining of follow up eGFR was between 45 and 60, 30-45 and 15-30 ml/min/1.73m 2 in 479 (29.8%), 551(34.2%), and 580(36.0%) patients, respectively. LFT levels were available at initial evaluation in 288(17.9%) patients and 735(48.5%) had assessment of proteinuria (19.6% with LFT vs. 15.4% without LFT, p = 0.032). Median follow-up time was of 21 months, and 1223(76%) had at least 1 year of follow up. Overall, eGFR decline per month was − 0.05(− 0.26, 0.23) ml/min/1.73m 2 , reaching 1.7(1.3, 2.4) ml/min/1.73m 2 by the end of study period. Similar results were obtained using CKD-EPI. Multivariable mixed linear analysis showed that proteinuria and age were independently associated with eGFR decline, with no effect of LFT, and no interaction between proteinuria and LFT. In patients without proteinuria, there was an improvement of eGFR despite the presence of LFT. Conclusions: We confirmed a faster rate of eGFR declined in patients with proteinuria. However, despite the pathophysiological rational that hypothyroidism can lead to increased rate of CKD progression, we failed to demonstrate an association between LFT and rate of CKD progression. We conclude that the benefit of hypothyroidism treatment in CKD patients needs to be evaluate in prospective studies.

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Unresolved Subclinical Hypothyroidism is Independently Associated with Progression of Chronic Kidney Disease

Cited by 15 publications

References 24 publications

Thyroid dysfunctions in patients with chronic renal failure

Thyroid dysfunctions in patients with chronic renal failure

Relationship between Thyroid Function and Kidney Function in Patients with Type 2 Diabetes

Influence of low free thyroxine on progression of chronic kidney disease

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