2013
DOI: 10.2215/cjn.06920712
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Hypothyroidism and Mortality among Dialysis Patients

Abstract: SummaryBackground and objectives Hypothyroidism is highly prevalent among ESRD patients, but its clinical significance and the benefits of thyroid hormone replacement in this context remain unclear.Design, setting, participants, & measurements This study examined the association between hypothyroidism and all-cause mortality among 2715 adult dialysis patients with baseline thyrotropin levels measured between April of 2005 and April of 2011. Mortality was ascertained from Social Security Death Master Index and … Show more

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Cited by 73 publications
(79 citation statements)
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“…Chang et al (14) also observed that a 10-ng/dl higher T3 level was associated with a 31% lower risk of sudden death, and this association was robust in analyses that accounted for competing risks. In contrast to previously published reports, TSH and free T4 levels were not associated with all-cause or cardiovascular death (15,16). However, this study excluded patients whose thyroid functional tests showed overt hypothyroidism (i.e., high TSH and low free T4) or hyperthyroidism (i.e., low TSH) as well as those with known hypo-and hyperthyroidism, which may have restricted the range of observed TSH and free T4 values in this study population (14).…”
contrasting
confidence: 99%
“…Chang et al (14) also observed that a 10-ng/dl higher T3 level was associated with a 31% lower risk of sudden death, and this association was robust in analyses that accounted for competing risks. In contrast to previously published reports, TSH and free T4 levels were not associated with all-cause or cardiovascular death (15,16). However, this study excluded patients whose thyroid functional tests showed overt hypothyroidism (i.e., high TSH and low free T4) or hyperthyroidism (i.e., low TSH) as well as those with known hypo-and hyperthyroidism, which may have restricted the range of observed TSH and free T4 values in this study population (14).…”
contrasting
confidence: 99%
“…In primary analyses, we examined thyroid function using granular categories of TSH, defined according to the usual TSH ranges for these designations as overt-hyperthyroid range (Ͻ0.1 mIU/L), subclinical-hyperthyroid range (0.1-Ͻ0.5 mIU/L), lownormal (0.5-Ͻ3.0 mIU/L), high-normal (3.0 -Ͻ5.0 mIU/L), subclinical-hypothyroid range (5.0 -Ͻ10.0 mIU/L), and overt-hypothyroid range TSH levels (Ն10.0 mIU/L) (3,5). We also conducted secondary analyses in which we defined thyroid function according to thresholds used in the general population: hyperthyroidism, euthyroidism, and hypothyroidism (defined as TSH Ͻ0.5, 0.5-Ͻ5.0, and Ն5.0 mIU/L, respectively) (19).…”
Section: Exposure Ascertainmentmentioning
confidence: 99%
“…To explore potential causal pathways that might mediate the association between hypothyroidism and mortality, we conducted sensitivity analyses in which we added covariate terms for potential pathway intermediates to the expanded case mix ϩ laboratory-adjusted model and observed for attenuation of effect estimates. These covariates included CHF, atherosclerotic disease, and residual kidney function (3,14). To determine whether the PD prescription and transport function characteristics may influence thyroid function-mortality associations, we additionally examined an expanded case mix ϩ laboratory ϩ PD characteristics model, which included covariates in the expanded case mix ϩ laboratory test model, as well as the use of automated PD during the baseline quarter and PET characteristics (D/P Cr ratio and 4-h PET ultrafiltration volume).…”
Section: Statistical Analysesmentioning
confidence: 99%
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