♦ Aims: We investigated dialysis duration, dose of erythropoietin (EPO), and clinical manifestations in peritoneal dialysis (PD) patients with subclinical hypothyroidism. ♦ Methods: This cross-sectional study, performed in 3 centers, assessed 122 adult patients on PD for more than 6 months with regard to demographic data, dialysis duration, thyroid function, biochemical data, EPO dose, and clinical manifestations. Thyroid dysfunction was determined by serum thyroid-stimulating hormone, free thyroxine, total thyroxine, total triiodothyronine, antithyroid peroxidase antibodies, and auto-antibodies against thyroglobulin. ♦ Results: Of the 122 study patients, 98 (80.3%) were assessed as having euthyroidism; 19 (15.6%), subclinical hypothyroidism; and 5 (4.1%), subclinical hyperthyroidism. The proportion of women (74.2% vs. 57.1%, p = 0.038), the mean duration of PD (58.1 months vs. 37.9 months, p = 0.032), and the weighted mean monthly EPO dose (1.22 μg/kg vs. 1.64 μg/kg, p = 0.009 ) were significantly higher in the subclinical hypothyroidism group than in the euthyroidism group, but the prevalences of coronary artery disease and cerebrovascular disease were not. From the multivariate model, PD duration was more significant than sex as a risk factor for subclinical hypothyroidism (p = 0.0132). ♦ Conclusions: Subclinical hypothyroidism is frequent in PD patients, especially female patients and patients with a longer PD duration. Compared with euthyroid patients, patients with subclinical hyperthyroidism need a higher dose of EPO to maintain a stable hemoglobin level.

Background: Protein-energy wasting (PEW) is common and associated with poor outcome in hemodialysis patients. In hemodialysis patients, geriatric nutritional risk index (GNRI) and decoy receptor 3 (DcR3) have been shown as the nutritional and inflammatory markers, respectively. The present study aimed to assess the predictive ability of GNRI and DcR3 for PEW status and long-term outcomes in chronic hemodialysis patients. Methods: A prospective cohort of 318 hemodialysis patients was conducted with a median follow-up of 54 months. Malnutrition-inflammation score (MIS) was used as the reference standard for the presence of PEW. Endpoints were cardiovascular and all-cause mortality. Results: Baseline GNRI had a strong negative correlation with DcR3 and MIS score. For patients with age < or ≥60, high DcR3 and low GNRI were independent predictors for the presence of PEW at baseline. At the end of the study, 81 patients died (27 cardiovascular deaths). The adjusted hazard ratios (95% confidence intervals) of low GNRI and high DcR3 were 1.93 (1.1-4.8) and 2.53 (1.2-5.5) for cardiovascular mortality and 1.85 (1.1-3.2) and 2.37 (1.5-3.7) for all-cause mortality, respectively. While integrated into a model of conventional risk factors, GNRI together with DcR3 further significantly improved the predictability for overall mortality (c statistic, 0.823). Conclusions: Low GNRI and high DcR3 were the alternatives for identifying hemodialysis patients at risk of PEW and overall mortality. Further studies are needed to verify whether timely recognition of hemodialysis patients with a high malnutrition-inflammation risk could reduce their mortality by appropriate interventional strategies.

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In HD patients, the EPO dosage required to maintain the target hemoglobin level is significantly higher in patients having both hypothyroidism or subclinical hypothyroidism and diabetes than in euthyroid patients.

The use of EPO in most HD patients to correct renal anemia [8,9] may also mask the similar symptoms and signs between hypothyroidism and uremia (i.e., anemia, lethargy, constipation, cold intolerance, and poor appetite) [10,11], thus making diagnosis of hypothyroidism difficult. Furthermore, the association of EPO with L-thyroxine therapy remains largely unknown [11][12][13][14]. Attempts to normalize circulating thyroid hormone for the EPO response may be harmful to HD patients with hypothyroidism, who may suffer excessive waste of protein nitrogen [1,2]. With hypothyroidism left untreated, the dosage of EPO can be increased to overcome the EPO resistance in HD patients. AbstractAim: This study investigated the effect of L-thyroxine on clinical manifestations and EPO responses, and the approach to L-thyroxine dosage adjustment for HD patients with Incidental hypothyroidism.Methods: Ten cases of Incidental hypothyroidism were diagnosed in 695 HD patients. In this study, L-thyroxine therapy was given only to hypothyroid HD patients with clinical symptoms, hematocrit <35%, and whose hypothyroidism was caused by medications which could not be discontinued. The initial dosage of L-thyroxine was 0.025 mg daily, and continuous adjustment was made according to clinical manifestations, patient's tolerance of L-thyroxine, and hematocrit level rather than TSH, T4 or FT4 value. Results:Of the 10 cases of Incidental hypothyroidism, 2 were autoimmune-induced, 5 were non-autoimmuneinduced, 2 were amiodarone-induced, and 1 was interferon-induced. Among them, 7 were treated with L-thyroxine and 3 were not. After L-thyroxine therapy, all 7 patients got symptoms improvement with 3 having EPO dosage reduced by more than 20%, 3 having hematocrit increased by more than 20%, and no patient requiring blood transfusion to keep hematocrit >30%. The clinical manifestations were found to improve after discontinuation of medications in two of those three patients with medication-induced hypothyroidism. L-thyroxine therapy may not be required for HD patients with hypothyroidism and hematocrit >35%.Conclusions: Adjustment of L-thyroxine dosage according to clinical manifestations, rather than TSH, T4 or FT4 value, is a practical and effective treatment approach for HD patients with hypothyroidism. This approach of L-thyroxine therapy could reduce EPO dosage, and improve both anemia and clinical symptoms.Whether the identified HD patients with hypothyroidism should be treated with L-thyroxine for the action of EPO on the bone marrow or left untreated for energy conservation is worth further investigation. The aim of this study is to investigate the effect of L-thyroxine on clinical manifestations and EPO responses, and the approach to L-thyroxine dosage adjustment for HD patients with Incidental hypothyroidism. Methods Thyroid function test, definitions of hypothyroidism and Incidental hypothyroidismVenous blood samples were drawn immediately before HD and sent to the central laboratory at TVGH for measurement of serum