Low-T3 Syndrome in Peritoneal Dialysis

Rhee, Connie M.

doi:10.2215/cjn.04310415

Cited by 15 publications

(5 citation statements)

References 20 publications

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“…3 Various CKDrelated factors may lead to reduced conversion of T4-to-T3 in peripheral organs including the kidneys. [82][83][84][85] For example, chronic metabolic acidosis affects iodothyronine deiodination, reducing the peripheral conversion of T4-to-T3. 72 The presence of inflammatory cytokines such as tumor necrosis factor (TNF)-a 86,87 and interleukin (IL)-1 87 also inhibit the expression of type 1 5'-deiodinase needed for T4-to-T3 conversion.…”

Section: Triiodothyronine (T3)mentioning

confidence: 99%

The Interplay Between Thyroid Dysfunction and Kidney Disease

Narasaki

Sohn

Rhee

2021

Seminars in Nephrology

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Section: Triiodothyronine (T3)mentioning

confidence: 99%

The Interplay Between Thyroid Dysfunction and Kidney Disease

Narasaki

Sohn

Rhee

2021

Seminars in Nephrology

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“…Although there has been comparatively less study of the peritoneal dialysis (PD) population, patients treated with PD may also be at heightened risk of thyroid functional disease via unique pathways (6). 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).…”

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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

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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)

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“…NTIS is highly prevalent in patients with CKD, and it has value as a predictor of CKD exacerbation ( 20 ) and poor outcomes in patients with ESRD ( 21 ). In NTIS, serum FT3 is decreased relative to serum FT4 without dysregulated TSH because of decreased T4 to T3 de-iodination caused by various factors, such as inflammation and malnutrition ( 22 ). This process occurs mainly in the skeletal muscle ( 23 ).…”

Section: Discussionmentioning

confidence: 99%

The serum free triiodothyronine to free thyroxine ratio as a potential prognostic biomarker of chronic kidney disease in patients with glomerular crescents: A retrospective study

Zhang

Nie

et al. 2022

Front. Endocrinol.

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BackgroundCrescent formation indicates severe glomerular pathology, and hypothyroidism usually predicts poor prognosis for severe diseases. However, the relationship between thyroid function and the progression of chronic kidney disease (CKD) is unclear. This study analysed the prognostic predictive value of the serum free triiodothyronine (FT3) to free thyroxine (FT4) ratio and its correlation with renal function in patients with CKD with crescent formation.MethodsThis single-centre study included 162 CKD patients with glomerular crescents confirmed by renal pathology between March 2012 and December 2014. According to the first tertile (0.284) of FT3/FT4 ratio, the patients were divided into high and low FT3/FT4 ratio groups. Kaplan-Meier and Cox regression analyses were performed to evaluate the prognostic value of the FT3/FT4 ratio.ResultsThe age, haemoglobin, eGFR, urinary albumin-to-creatinine ratio, cardiac troponin T, N-terminal brain natriuretic peptide precursor, FT3, FT4, percentage of total crescents in non-globally sclerotic glomeruli, prevalences of hypertension, moderate to severe renal tubulopathy and crescentic nephritis, and proportion of patients receiving glucocorticoids and immunosuppressants were significantly different between high and low FT3/FT4 ratio groups (P < 0.05). Multivariate Cox regression analysis showed that when compared with patients with a high FT3/FT4 ratio (>0.284), those with intermediate and low FT3/FT4 ratios (≤0.284) had an increased risk of the long-term composite endpoint (P < 0.05 for various adjustment models).ConclusionsA low FT3/FT4 ratio is associated with increased mortality and worse outcome risk in CKD patients with crescent pathology.

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Low-T3 Syndrome in Peritoneal Dialysis

Cited by 15 publications

References 20 publications

The Interplay Between Thyroid Dysfunction and Kidney Disease

The Interplay Between Thyroid Dysfunction and Kidney Disease

Thyroid Functional Disease and Mortality in a National Peritoneal Dialysis Cohort

The serum free triiodothyronine to free thyroxine ratio as a potential prognostic biomarker of chronic kidney disease in patients with glomerular crescents: A retrospective study

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