Low Free Triiodothyronine Level as a Predictor of Cardiovascular Events and All-Cause Mortality in Patients Undergoing Hemodialysis: The DREAM Cohort

Yamazaki, Yuko; Shoji, Tetsuo; Miyashima, Masako; Nagata, Yuki; Kakutani, Yoshinori; Ochi, Akinobu; Morioka, Tomoaki; Nakatani, Shinya; Mori, Katsuhito; Tsujimoto, Yoshihiro; Emoto, Masanori

doi:10.5551/jat.60624

Cited by 10 publications

(15 citation statements)

References 34 publications

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“…Another study observed that low T3 is a powerful factor of mortality and low cardiac output in CABG patients (17). A recent Japanese study demonstrated low fT3 to be a predictor of MACE and all-cause mortality in hemodialysis patients (30). Multiple studies have reported low T3 levels to be a predictor of poor prognosis in acute and chronic heart failure (12,13,31,32).…”

Section: Discussionmentioning

confidence: 99%

Low Free Triiodothyronine as a Predictor of Poor Prognosis in Patients With Myocardial Infarction With Non-Obstructive Coronary Arteries

et al. 2021

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BackgroundLow free triiodothyronine (fT3) level is strongly associated with poor prognosis in various patient populations. However, the role of fT3 in the risk of clinical outcomes in myocardial infarction with non-obstructive coronary arteries (MINOCA) has not been studied. Our study aimed to evaluate the association between low fT3 levels and the clinical outcomes of MINOCA patients.MethodsA total of 218 MINOCA patients without a history of thyroid disease were enrolled in the study. Demographic, baseline clinical data, thyroid hormones, and other biochemical parameters were assessed in all patients. According to the fT3 levels, the present study was classified into two groups: the low fT3 group (fT3<3.5 pmol/L) and the normal fT3 group (fT3 3.5-6.5 pmol/L). The endpoint of the study was major adverse cardiac events (MACE).ResultsFifty-nine patients were in the low fT3 group and 159 patients were in the normal fT3 group. Over the two years of follow-up, 36 MACE have occurred. The occurrence of MACE was higher in the low fT3 group compared with normal fT3 group (25.4% vs 13.2%; P=0.031). Kaplan-Meier survival curves showed a significantly increased risk of MACE in patients with low fT3 (log-rank P=0.027). Multivariable logistic regression analysis stated that high fT3 was independently associated with lower risk of MACE after two years of follow up (OR, 0.623; 95% CI, 0.399- 0.972; P=0.037).ConclusionLow fT3 levels were significantly associated with increased risk of MACE in patients with MINOCA. This finding suggests that the fT3 levels may serve as a potential biomarker in risk stratification of MINOCA patients.

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Section: Discussionmentioning

confidence: 99%

Low Free Triiodothyronine as a Predictor of Poor Prognosis in Patients With Myocardial Infarction With Non-Obstructive Coronary Arteries

et al. 2021

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“…Accepted for publication: August 10, 2021 Published online: September 11, 2021 was defined by 1) being treated with levothyroxine replacement (treated hypothyroidism) or 2) low free T4 ( 0.8 ng/dL) with high TSH ( 4.0 IU/L) 25) . No patients had central hypothyroidism (low free T4 with low TSH).…”

Section: Advance Publication Journal Of Atherosclerosis and Thrombosismentioning

confidence: 99%

Associations of Serum Insulin-Like Growth Factor 1 with New Cardiovascular Events and Subsequent Death in Hemodialysis Patients: The DREAM Cohort

Nakaya

Shoji

Nagata

et al. 2022

JAT

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Patients with chronic kidney disease (CKD) have elevated risk of death from cardiovascular disease (CVD).A low serum insulin-like growth factor 1 (IGF-1) level is known to predict higher risk for all-cause mortality in incident dialysis patients, although it is unknown whether IGF-1 predicts cardiovascular outcomes.Methods: This was a prospective cohort study of maintenance hemodialysis patients followed up for 5 years. Serum IGF-1 levels were measured at baseline, and patients were divided into IGF-1 tertiles. The key outcomes were all-cause mortality, a composite of new CVD, and death after new CVD events. Additional outcomes were hospitalization for infection and subsequent death. Association was analyzed using Cox proportional hazards models. Results:In the 516 patients that were analyzed, we identified 106 all-cause deaths, 190 new CVD events, and 61 subsequent deaths. In addition, there were 169 hospitalizations for infection and 47 subsequent deaths. The risk of all-cause death was the highest in the lowest IGF-1 tertile, and this association remained significant in multivariable-adjusted models. Regarding CVD outcomes, IGF-1 was not associated with new CVD events but significantly associated with subsequent death in adjusted models. Similarly, IGF-1 was not an independent predictor of hospitalization for infection, but it predicted subsequent death. Conclusions:A low IGF-1 level was not a significant predictor of new CVD events but an independent predictor of subsequent death in hemodialysis patients. Since similar associations with infection outcomes were observed, IGF-1 may be a biomarker of fragility or frailty in this population.(CVD) but also for death after CVD events 2) . These two factors synergistically increase the risk of cardiovascular death 3) .The elevated risk of CVD death in patients with chronic kidney disease (CKD), including those on hemodialysis, has been explained by the traditional and nontraditional risk factors 4) . Obesity is one of the Copyright©2021 Japan Atherosclerosis Society This article is distributed under the terms of the latest version of CC BY-NC-SA defined by the Creative Commons Attribution License.

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“…The present study was conducted as a cross-sectional analysis of our prospective study cohort termed DREAM (Dialysis-Related Endocrine And Metabolic changes affecting cardiovascular disease) [11,16,17]. The total of 806 dialysis patients were treated at Inoue Hospital, Suita, Osaka, Japan, in December 2004.…”

Section: Selection Of Subjectsmentioning

confidence: 99%

“…Blood samples were drawn from the arteriovenous fistula just prior to an HD session at the beginning of the week, three days after the previous HD session, as previously reported [18]. Serum levels of FT3, FT4, and TSH were measured by specific chemiluminescent immunoassay (CLIA) methods performed by BIO MEDICAL LABORATORIES (BML, Inc., Tokyo, Japan), as previously described [11]. The reference ranges for FT3, FT4, and TSH were 2.2-4.1 pg/mL, 0.8-1.9 ng/dL, and 0.4-4.0 µIU/mL, respectively.…”

Section: Measurement Of Thyroid Hormones In Serummentioning

confidence: 99%

“…Although TSH has been considered to be the most sensitive single measure of thyroid function for accurate classification of hypothyroidism [4], it is increasingly being recognized that, because of its direct biologic action [5], a reduction in serum FT3 may indicate hypothyroidism in CKD and ESRD patients in spite of normal TSH [6,7]. Although its significance is generally under-recognized, low T3 syndrome is highly prevalent in dialysis patients [8], and it has been speculated that this syndrome is a physiologic adaptation to conserve metabolism in dialysis patients prone to hypercatabolism, dialytic protein and amino acid losses, and protein-energy wasting [9,10], by decreasing T3-stimulated metabolism [5,11]. The mechanism by which serum FT3 decreases relative to serum FT4 in spite of normal TSH is mainly explained by a decreased T4 to T3 deiodination process caused by various factors, such as inflammation and malnutrition [12], mainly in skeletal muscle [13].…”

Section: Introductionmentioning

confidence: 99%

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Association of Reduced Free T3 to Free T4 Ratio with Lower Serum Creatinine in Japanese Hemodialysis Patients

Inaba¹,

Mori

Tsujimoto

et al. 2021

Nutrients

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Purpose: Low T3 syndrome is defined by a fall in free triiodothyronine (FT3) in spite of normal serum thyroid-stimulating hormone (TSH) and often normal free thyroxin (FT4). A low FT3/FT4 ratio, a relevant marker for low T3 syndrome, is known as a risk of mortality in hemodialysis (HD) patients, as well as low muscle mass in the general population. Because of the local activation of T4 to FT3 in muscle tissue, we examined the association of FT3/FT4 ratio with serum creatinine, a marker of muscle mass and strength in HD patients to investigate the significance of muscle tissue in the development of low T3 syndrome in HD patients. Methods: This was a cross-sectional study derived from our prospective cohort study, named DREAM, of Japanese HD patients. After the exclusion of patients with treated and untreated thyroid dysfunction, 332 patients were analyzed in the study. Results: The serum FT4 and TSH of HD patients (n = 332) were 0.9 ± 0.1 ng/dL. and 2.0 ± 0.9 μIU/mL, which were within the respective normal range, while serum FT3 was 2.2 ± 0.3 pg/mL. As many as 101 out of 332 (30.4%) HD patients exhibited a serum FT3 less than the normal lower limit of 2.2 pg/mL. The serum FT3/FT4 ratio correlated significantly positively with serum creatinine, and inversely with serum log CRP and total cholesterol, while it exhibited a tendency towards positive correlation with serum albumin. Multiple regression analysis, which included serum creatinine, albumin, and log CRP, simultaneously, in addition to sex, age, diabetic kidney disease or not, log HD duration, body mass index, systolic blood pressure, and Kt/V, as independent variables, revealed an independent and significant positive association of serum creatinine, but not serum albumin or CRP, with the serum FT3/FT4 ratio. Conclusions: The present study demonstrated an independent and positive correlation of serum creatinine with the serum FT3/FT4 ratio in HD patients. The lack of association of the serum FT3/FT4 ratio with serum albumin and CRP suggested the presence of a creatinine-specific mechanism to associate with serum FT3/FT4 ratio. Because of the local activation of T4 to T3 at muscle tissue, a lower muscle mass may be causatively associated with low T3 syndrome.

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Low Free Triiodothyronine Level as a Predictor of Cardiovascular Events and All-Cause Mortality in Patients Undergoing Hemodialysis: The DREAM Cohort

Cited by 10 publications

References 34 publications

Low Free Triiodothyronine as a Predictor of Poor Prognosis in Patients With Myocardial Infarction With Non-Obstructive Coronary Arteries

Low Free Triiodothyronine as a Predictor of Poor Prognosis in Patients With Myocardial Infarction With Non-Obstructive Coronary Arteries

Associations of Serum Insulin-Like Growth Factor 1 with New Cardiovascular Events and Subsequent Death in Hemodialysis Patients: The DREAM Cohort

Association of Reduced Free T3 to Free T4 Ratio with Lower Serum Creatinine in Japanese Hemodialysis Patients

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