Impact of Thyroid Dysfunction on Erythropoietin Dosage in Hemodialysis Patients

Ng, Yee Yung; Lin, Hong; Wu, Shiao Chi; Yang, Chih Yu; Wu, Yang Chang; Liou, Hung-Hsiang; Hu, Fen Hsiang; Chun, Hou; Tseng, Su Shan; Ku, Nai Yung; Hsiao, Nien Yung; Wu, Wen Chi; Tu, Hsing Meng; Lien, Tse Jen; Lee, Chung Ching; Tsang, Kwong Kee; Cheng, Chen Seng; Hu, Jiang; Lin, Ru

doi:10.1089/thy.2011.0495

Cited by 10 publications

(7 citation statements)

References 51 publications

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“…Surprisingly, there was a lower prevalence of positive thyroid autoantibodies in the patients with ESRD (∼5.5% of ATPO antibody and ∼9% of ATG antibody vs. ∼15% and ∼18%, respectively, in the control group). One possible explanation would be the severe impact of ESRD in the host immune system, which remains impaired regardless of maintenance dialysis …”

Section: Discussionmentioning

confidence: 99%

“…One possible explanation would be the severe impact of ESRD in the host immune system, which remains impaired regardless of maintenance dialysis. 22 There are several arguments that justify why thyroid work-up is appropriate in patients undergoing dialysis. The main reason is that patients with ESRD are in greater chance for developing thyroid cancer.…”

Section: Discussionmentioning

confidence: 99%

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High prevalence of subclinical hypothyroidism and nodular thyroid disease in patients on hemodialysis

Costa

Pellizzari

Carvalho

et al. 2015

Hemodialysis International

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Chronic kidney disease has been known to affect thyroid hormone metabolism. Low serum levels of T3 and T4 are the most remarkable laboratorial findings. A high incidence of goiter and nodules on thyroid ultrasonography has been reported in patients with end-stage renal disease (ESRD). Our objective is to evaluate the prevalence of laboratorial and morphologic alterations in the thyroid gland in a cohort of patients with ESRD on hemodialysis (HD). Sixty-one patients with ESRD on HD were selected and compared with 43 healthy subjects matched by age, gender, and weight. Patients were submitted to thyroid ultrasonography. T3, free T4 (FT4), thyroid-stimulating hormone, antithyroglobulin, and antithyroperoxidase antibodies were measured. The mean age of patients with ESRD was 47.4 ± 12.3 and 61% were women. ESRD was mainly caused by hypertensive nephrosclerosis and diabetic nephropathy. Mean thyroid volume, as determined by ultrasonography, was similar in both groups. Patients with ESRD had more hypoechoic nodules when compared with the control group (24.1% vs. 7.9%, P = 0.056). Mean serum FT4 and T3 levels were significantly lower in patients with ESRD, and subclinical hypothyroidism was more prevalent in patients with ESRD (21.82% vs. 7.14% control group, P = 0.04). Titers of antithyroid antibodies were similar in both groups. ESRD was associated with a higher prevalence of subclinical hypothyroidism and lower levels of T3 and FT4. Almost a quarter of patients showed thyroid nodules >10 mm. Periodic ultrasound evaluation and assessment of thyroid function are recommended in patients with ESRD on HD.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

High prevalence of subclinical hypothyroidism and nodular thyroid disease in patients on hemodialysis

Costa

Pellizzari

Carvalho

et al. 2015

Hemodialysis International

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“…Anemia may be observed in up to 43 and 39% of patients with overt and subclinical hypothyroidism, respectively, and may relate to one or more of decreased erythropoietin production, iron deficiency (due to impaired intestinal absorption and incorporation of iron into erythrocytes), vitamin B12 deficiency (in association with autoimmune thyroid disease and pernicious anemia) and blood loss associated with impaired hemostasis (Supplementary data, Figure S1) [131][132][133][134][135]. Hypothyroid HD patients have been observed to require higher monthly ESA doses compared with their euthyroid counterparts, independent of case-mix differences [136]. In a randomized controlled trial of patients with coexisting subclinical hypothyroidism and iron deficiency anemia, those assigned to oral iron and exogenous thyroid hormone experienced a greater rise in hemoglobin, iron and ferritin compared with those receiving oral iron alone [132].…”

Section: F I G U R E 1 : Mechanisms Of Hypothyroidism and Cardiovascumentioning

confidence: 99%

Thyroid functional disease: an under-recognized cardiovascular risk factor in kidney disease patients

Rhee¹,

Brent²,

Kövesdy³

et al. 2014

Nephrology Dialysis Transplantation

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Thyroid functional disease, and in particular hypothyroidism, is highly prevalent among chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients. In the general population, hypothyroidism is associated with impaired cardiac contractility, endothelial dysfunction, atherosclerosis and possibly higher cardiovascular mortality. It has been hypothesized that hypothyroidism is an under-recognized, modifiable risk factor for the enormous burden of cardiovascular disease and death in CKD and ESRD, but this has been difficult to test due to the challenge of accurate thyroid functional assessment in uremia. Low thyroid hormone levels (i.e. triiodothyronine) have been associated with adverse cardiovascular sequelae in CKD and ESRD patients, but these metrics are confounded by malnutrition, inflammation and comorbid states, and hence may signify nonthyroidal illness (i.e. thyroid functional test derangements associated with underlying ill health in the absence of thyroid pathology). Thyrotropin is considered a sensitive and specific thyroid function measure that may more accurately classify hypothyroidism, but few studies have examined the clinical significance of thyrotropin-defined hypothyroidism in CKD and ESRD. Of even greater uncertainty are the risks and benefits of thyroid hormone replacement, which bear a narrow therapeutic-to-toxic window and are frequently prescribed to CKD and ESRD patients. In this review, we discuss mechanisms by which hypothyroidism adversely affects cardiovascular health; examine the prognostic implications of hypothyroidism, thyroid hormone alterations and exogenous thyroid hormone replacement in CKD and ESRD; and identify areas of uncertainty related to the interplay between hypothyroidism, cardiovascular disease and kidney disease requiring further investigation.

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“…However, thyroid hormones also influence peripheral tissue oxygen consumption and seem to influence other participants in erythropoiesis, such as hypoxia inducible factor 1, which is known to induce various forms of anemia. Overt hypothyroidism was proposed as a cause of EPO resistance in dialysis patients, assuming euthyroid status is needed for a normal response to recombinant EPO 42 ; however only one observational study has established the relationship between hypothyroidism and EPO dosages 43 . Further studies are warranted to evaluate whether thyroid hormone replacement reduces EPO and iron needs in CKD patients.…”

Section: Renal Diseasementioning

confidence: 99%

Hypothyroidism and chronic kidney disease: An undervalued two-way relationship

Coutinho¹,

Santos²,

Rocha³

2020

pjnh

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There is long-standing evidence that thyroid disease and kidney disease have a two-way relationship, as they can aggravate and lead to each other. The exact nature of this association and its clinical implications have been a matter of debate, as co-sharing of risk factors and appropriate prospective studies that allow for causal relationships to be inferred are lacking. Hypothyroidism is currently regarded by the American Heart Association as a modifiable cardiovascular risk factor and a reversible cause of heart failure. Among the nephrology community, while hypothyroidism has been an increasingly prevalent issue, formal guidelines on how to proceed when such association occurs are lacking and its clinical implications are often underappreciated among practitioners. Whether renal disease caused the thyroid disturbance or vice-versa, there is evidence pointing to thyroid dysfunction being a risk factor for incident chronic kidney disease and its progression and it is linked to increased overall mortality in CKD patients. The authors provide a review of current scientific evidence on this complex relationship.

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Impact of Thyroid Dysfunction on Erythropoietin Dosage in Hemodialysis Patients

Abstract: 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.

Cited by 10 publications

References 51 publications

High prevalence of subclinical hypothyroidism and nodular thyroid disease in patients on hemodialysis

High prevalence of subclinical hypothyroidism and nodular thyroid disease in patients on hemodialysis

Thyroid functional disease: an under-recognized cardiovascular risk factor in kidney disease patients

Hypothyroidism and chronic kidney disease: An undervalued two-way relationship

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