Associations of Triiodothyronine Levels with Carotid Atherosclerosis and Arterial Stiffness in Hemodialysis Patients

Tatar, Erhan; Kırçelli, Fatih; Aşçı, Gülay; Carrero, Juan Jesús; Güngör, Özkan; Demirci, Meltem Seziş; Özbek, Süreyya; Ceylan, Naim; Özkahya, Mehmet; Töz, Hüseyin; Ok, Ercan

doi:10.2215/cjn.02540311

Cited by 58 publications

(58 citation statements)

References 38 publications

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“…At a cardiac level, low T3 levels in CKD patients are associated with reduced left ventricular function, increased left ventricular mass (13), and elevated intimamedia thickness (12). Our study also adds novel evidence regarding the association between trimestral T3 variation and all-cause and CV mortality in ESRD.…”

Section: Discussionsupporting

confidence: 54%

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Baseline Levels and Trimestral Variation of Triiodothyronine and Thyroxine and Their Association with Mortality in Maintenance Hemodialysis Patients

Meuwese

Dekker

Lindholm

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Conflicting evidence exists with regard to the association of thyroid hormones and mortality in dialysis patients. This study assesses the association between basal and trimestral variation of thyroid stimulating hormone, triiodothyronine, and thyroxine and mortality.Design, setting, participants, & measurements In 210 prevalent hemodialysis patients, serum triiodothyronine, thyroxine, thyroid stimulating hormone, and interleukin-6 were measured 3 months apart. Cardiovascular and non-cardiovascular deaths were registered during follow-up. Based on fluctuations along tertiles of distribution, four trimestral patterns were defined for each thyroid hormone: persistently low, decrease, increase, and persistently high. The association of baseline levels and trimestral variation with mortality was investigated with Kaplan-Meier curves and Cox proportional hazard models.Results During follow-up, 103 deaths occurred. Thyroid stimulating hormone levels did not associate with mortality. Patients with relatively low basal triiodothyronine concentrations had higher hazards of dying than patients with high levels. Longitudinally, patients with persistently low levels of triiodothyronine during the 3-month period had higher mortality hazards than those having persistently high levels. These associations were mainly attributable to cardiovascular-related mortality. The association between thyroxine and mortality was not altered after adjustment for triiodothyronine.Conclusions Hemodialysis patients with reduced triiodothyronine or thyroxine levels bear an increased mortality risk, especially due to cardiovascular causes. This was true when considering both baseline measurements and trimestral variation patterns. Our longitudinal design adds observational evidence supporting the hypothesis that the link may underlie a causal effect.

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Section: Discussionsupporting

confidence: 54%

“…However, growing evidence suggests participation of T3 in the pathophysiology of endothelial dysfunction (11), atherosclerosis (12), and cardiac abnormalities (13) of CKD patients. Some studies, with somewhat conflicting results, have also implicated thyroid alterations in the mortality risk of CKD patients (14)(15)(16).…”

Section: Introductionmentioning

confidence: 99%

Baseline Levels and Trimestral Variation of Triiodothyronine and Thyroxine and Their Association with Mortality in Maintenance Hemodialysis Patients

Meuwese

Dekker

Lindholm

et al. 2012

Clinical Journal of the American Society of Nephrology

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“…Endothelial dysfunction has been reported in patients with hypothyroidism. Yilmaz et al (114) reported a strong correlation between decreased fT3 and endothelial dysfunction in stage 3 to 4 CKD patients and Tatar et al (115)(116) reported an association of low fT3 and several parameters of CVD mortality, such as endothelial dysfunction and inflammation in HD and PD patients. Dyslipidemia is common in CKD and it can be aggravated by the altered thyroid metabolism observed in these patients (18).…”

Section: Dousdampanis Et Almentioning

confidence: 99%

The Thyroid and the Kidney: A Complex Interplay in Health and Disease

et al. 2014

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Thyroid hormones may directly affect the kidney and altered kidney function may also contribute to thyroid disorders. The renal manifestations of thyroid disorders are based on hemodynamic alterations or/and to direct effects of thyroid hormones. The renin-angiotensin system plays a crucial role in the cross-talk between the thyroid and the kidney. Hypothyroidism may be accompanied by an increase of serum creatinine and reduction of glomerular filtration rate (GFR), whereas hyperthyroidism may increase GFR. Treatment of thyroid disorders may lead to normalization of GFR. Primary and subclinical hypothyroidism and low triiodothyronine (T3) syndrome are common features in patients with chronic kidney disease (CKD). In addition low levels of thyroid hormones may predict a higher risk of cardiovascular and overall mortality in patients with end-stage renal disease. The causal nature of this correlation remains uncertain. In this review, special emphasis is given to the thyroid pathophysiology, its impact on kidney function and CKD and the interpretation of laboratorial findings of thyroid dysfunction in CKD.

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“…Recent advances in our understanding of the thyroid system have strongly implicated both subclinical hypothyroidism and low free triiodothyronine (fT3) levels in the cardiac and atherosclerotic abnormalities observed in non-renal patients 10) . On the other hand, Tatar et al recently demonstrated that low fT3 levels are associated with carotid atherosclerosis in HD patients 11,12) . Yilmaz et al demonstrated a relationship between low fT3 levels and endothelial dysfunction in patients suffering from renal failure 13) .…”

Section: Biochemical Measurementsmentioning

confidence: 99%

A Low Serum Free Triiodothyronine Level is Associated with Epicardial Adipose Tissue in Peritoneal Dialysis Patients

Koçyiğit

Güngör

Ünal

et al. 2014

J Atheroscler Thromb

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Aim: Cardiovascular disease is a major cause of mortality in dialysis patients. Epicardial adipose tissue (EAT) has been proposed as a cardiovascular risk marker in this population. Subclinical hypothyroidism and low free triiodothyronine (fT3) levels are associated with EAT in patients without chronic renal failure. The aim of this study was to investigate the relationship between EAT and low free T3 levels in peritoneal dialysis (PD) patients. Methods: A total of 125 prevalent PD patients were enrolled in this cross-sectional study. The epicardial fat thickness (EFT) was measured by echocardiography, and the endothelial function was assessed by flow mediated dilatation (FMD). Thyroid function tests were performed by an enzyme immunoassay. Results: The mean age of the patients was 51±13, and the time on PD was 36 months. The mean EFT was 6.7±2.9 mm. The EFT correlated positively with the patient age, systolic blood pressure (BP), mean BP, high sensitivity C-reactive protein (hs-CRP) level and body mass index (BMI), and negatively with the fT3 level and FMD. The median fT3 value was 2.53, and patients were divided according to their serum fT3 values (within the normal range and below the reference level). Compared with patients in the low fT3 group, the subjects in the normal fT3 group had higher serum albumin levels and FMD, but a lower BMI, plasma fasting glucose level, EFT, TSH level, hs-CRP level, low density lipoprotein (LDL) cholesterol level and mean BP in office measurements, and both the diastolic BP and mean BP by ambulatory blood pressure measurement. A multivariate linear regression analysis showed that the EFT was predicted by the hs-CRP and fT3 levels. Conclusion: Low free T3 levels are associated with the epicardial fat thickness in PD patients. Further studies are needed to evaluate the pathogenesis and to support these findings.

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Associations of Triiodothyronine Levels with Carotid Atherosclerosis and Arterial Stiffness in Hemodialysis Patients

Cited by 58 publications

References 38 publications

Baseline Levels and Trimestral Variation of Triiodothyronine and Thyroxine and Their Association with Mortality in Maintenance Hemodialysis Patients

Baseline Levels and Trimestral Variation of Triiodothyronine and Thyroxine and Their Association with Mortality in Maintenance Hemodialysis Patients

The Thyroid and the Kidney: A Complex Interplay in Health and Disease

A Low Serum Free Triiodothyronine Level is Associated with Epicardial Adipose Tissue in Peritoneal Dialysis Patients

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