Abnormal thyroid function in peritoneal dialysis patients: Lots of smoke but no fire

Lin, Yi; Tarng, Der Cherng

doi:10.1016/j.jcma.2011.12.001

Cited by 4 publications

(4 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Decreased thyroid function may be a protective mechanism to reduce protein catabolism [13]. Accordingly, several studies reported that elevated serum TSH level is associated with longevity [14, 15].…”

Section: Introductionmentioning

confidence: 99%

Association of TSH Elevation with All-Cause Mortality in Elderly Patients with Chronic Kidney Disease

et al. 2017

View full text Add to dashboard Cite

Chronic kidney disease (CKD) is a widespread condition in the global population and is more common in the elderly. Thyroid-stimulating hormone (TSH) level increases with aging, and hypothyroidism is highly prevalent in CKD patients. However, the relationship between low thyroid function and mortality in CKD patients is unclear. Therefore, we conducted a retrospective cohort study to examine the relationship between TSH elevation and all-cause mortality in elderly patients with CKD. This retrospective cohort study included individuals ≥65 years old with CKD (n = 23,786) in Taipei City. Health examination data from 2005 to 2010 were provided by the Taipei Databank for Public Health Analysis. Subjects were categorized according to thyroid-stimulating hormone (TSH) level as follows: low normal (0.34

show abstract

Section: Introductionmentioning

confidence: 99%

Association of TSH Elevation with All-Cause Mortality in Elderly Patients with Chronic Kidney Disease

et al. 2017

View full text Add to dashboard Cite

show abstract

“…For example, given that the vast majority (Ͼ99%) of thyroid hormone in the form of T 3 and T 4 is bound to carrier proteins such as T 4 -binding globulin, transthyretin, and serum albumin [molecular weights 54 kDa, 54 kDa, and 65 kDa, respectively (7)], PD patients may be susceptible to total body thyroid hormone depletion with substantial peritoneal effluent protein-hormone losses (8,9). Indeed, data from several small-sized PD cohorts suggest that ϳ15-25% and 4% of patients may have underlying hypo-and hyperthyroidism, respectively (10,11).…”

mentioning

confidence: 99%

Thyroid Functional Disease and Mortality in a National Peritoneal Dialysis Cohort

Rhee

Ravel

Streja

et al. 2016

The Journal of Clinical Endocrinology &Amp; Metabolism

View full text Add to dashboard Cite

Context and Objective: End-stage renal disease patients have a higher risk of thyroid disease compared with those without kidney disease. Although thyroid dysfunction is associated with higher death risk in the general population and those undergoing hemodialysis, little is known about the effect of thyroid disease upon mortality in patients treated with peritoneal dialysis (PD).Design, Setting, Participants, and Main Outcome: We examined the association of thyroid status, assessed by serum TSH, with all-cause mortality among PD patients from a large national dialysis organization who underwent one or more TSH measurements over 5 years (January 2007 to December 2011. Thyroid status was categorized as overt-hyperthyroid, subclinical-hyperthyroid, low-normal, high-normal, subclinical-hypothyroid, and overt-hypothyroid range (TSH Ͻ 0.1, 0.1-Ͻ0.5, 0.5-Ͻ3.0, 3.0 -Ͻ5.0, 5.0 -Ͻ10.0, and Ն10.0 mIU/L, respectively). We examined the association between TSH and mortality using case mix-adjusted time-dependent Cox models to assess shortterm thyroid function-mortality associations and to account for changes in thyroid function over time.Results: Among 1484 patients, 7 and 18% had hyperthyroidism and hypothyroidism, respectively, at baseline. We found that both lower and higher time-dependent TSH levels were associated with higher mortality (reference: TSH, 0.5-Ͻ3.0 mIU/L): adjusted hazard ratios (95% confidence intervals) 2.09 (1.08 -4.06), 1.53 (0.87-2.70), 1.05 (0.75-1.46), 1.63 (1.11-2.40), and 3.11 (2.08 -4.63) for TSH levels, Ͻ0.1, 0.1-Ͻ0.5, 0.5-Ͻ3.0, 3.0 -Ͻ5.0, 5.0 -Ͻ10.0, and Ն10.0 mIU/L, respectively. Conclusion:Time-dependent TSH levels Ͻ 0.1 mIU/L and Ն 5.0 mIU/L were associated with higher mortality, suggesting hyper-and hypothyroidism carry short-term risk in PD patients. Additional studies are needed to determine mechanisms underlying the thyroid dysfunction-mortality association, and whether normalization of TSH with treatment ameliorates mortality in this population. (J Clin Endocrinol Metab 101: 4054 -4061, 2016)

show abstract

“…Hypothyroidism was reported to be associated with increased mortality in CKD patients [1,2]. The hypothesis of an adaptive and protective effect of abnormal thyroid function in CKD patients has been suggested [3]. Recently, several studies reported that elevated serum TSH level is associated with longevity [4,5].…”

Section: Commentarymentioning

confidence: 99%

“…Should abnormal thyroid function be considered as a marker for survival drawback and not an etiological factor in CKD patients? [3]. Higher TSH levels were associated with greater risk of subsequent CKD, according to a cohort study of elderly persons in Taipei City [6].…”

mentioning

confidence: 99%

TSH Elevation and Chronic Kidney Disease in Elderly Adults

Chuang¹,

Hung²,

Chou³

2017

J Gerontol Geriatr Res

View full text Add to dashboard Cite

CommentaryChronic kidney disease (CKD) is common in the elderly. Thyroidstimulating hormone (TSH) progressively increases over time in older individuals, and hypothyroidism is highly prevalent in CKD patients. Hypothyroidism was reported to be associated with increased mortality in CKD patients [1,2]. The hypothesis of an adaptive and protective effect of abnormal thyroid function in CKD patients has been suggested [3]. Recently, several studies reported that elevated serum TSH level is associated with longevity [4,5]. However, the effect of thyroid function on CKD is unclear. Should abnormal thyroid function be considered as a marker for survival drawback and not an etiological factor in CKD patients? [3]. Higher TSH levels were associated with greater risk of subsequent CKD, according to a cohort study of elderly persons in Taipei City [6]. Mei-Hsing Chuang, MD, of Yang-Ming University in Taipei, and colleagues studied 41,454 non-CKD elderly adults who had received health examinations, including demographic characteristics, medical history, medication history, alcohol consumption, smoking status, vital status, and laboratory results. Subjects with DM (30.2% vs 23.4%), dyslipidemia (hypertriglyceridemia: 30.0% vs 23.8%; low HDL-C: 27.4% vs 23.4%), smoking (26.1% vs 24.4%), or obesity (28.4% vs 23.5%) had a greater risk of developing incident CKD. In adjusted analyses, the association between hypothyroidism and onset of CKD in the group without DM was significant. Subclinical hypothyroidism and overt hypothyroidism had an increased risk of developing CKD in non-DM patients (HR=1.19, 95% CI=1.07-1.31; HR=1.34, 95% CI=1.08-1.65, respectively). The study showed that the effects of comorbidities and DM can supersede the influence of hypothyroidism on CKD in individuals with DM.The likely biologic mechanism by which thyroid hormones affect kidney function seems to be by mediating on cardiac output and renal blood flow, contributing to changes in GFR. High serum creatinine also may explain the link between hypothyroidism and CKD [7][8][9][10][11].Although the study has a number of limitations, this finding suggests that thyroid function should be periodically checked in elderly adults to detect those individuals with abnormal thyroid function. Thyroid and renal function might be carefully monitored in persons with mildly abnormal TSH levels, because they are at risk of renal function decline. For elderly patients with CKD, the author also observed an increased death risk in individuals with TSH level higher than 5.2 mIU/L. It is also important for health care providers to acknowledge that periodic evaluation of TSH level in elderly CKD patients might be helpful to detect abnormal thyroid function [2]. However, a welldesigned randomized controlled trial is needed to evaluate the benefit of treating TSH elevation in elderly patients with CKD.

show abstract

Abnormal thyroid function in peritoneal dialysis patients: Lots of smoke but no fire

Cited by 4 publications

References 15 publications

Association of TSH Elevation with All-Cause Mortality in Elderly Patients with Chronic Kidney Disease

Association of TSH Elevation with All-Cause Mortality in Elderly Patients with Chronic Kidney Disease

Thyroid Functional Disease and Mortality in a National Peritoneal Dialysis Cohort

TSH Elevation and Chronic Kidney Disease in Elderly Adults

Contact Info

Product

Resources

About