Prevalence of Clinical and Subclinical Thyroid Disease in a Peritoneal Dialysis Population

Abstract

♦ Aims: We investigated dialysis duration, dose of erythropoietin (EPO), and clinical manifestations in peritoneal dialysis (PD) patients with subclinical hypothyroidism. ♦ Methods: This cross-sectional study, performed in 3 centers, assessed 122 adult patients on PD for more than 6 months with regard to demographic data, dialysis duration, thyroid function, biochemical data, EPO dose, and clinical manifestations. Thyroid dysfunction was determined by serum thyroid-stimulating hormone, free thyroxine, total thyroxine, total triiodothyronine, antithyroid peroxidase antibodies, and auto-antibodies against thyroglobulin. ♦ Results: Of the 122 study patients, 98 (80.3%) were assessed as having euthyroidism; 19 (15.6%), subclinical hypothyroidism; and 5 (4.1%), subclinical hyperthyroidism. The proportion of women (74.2% vs. 57.1%, p = 0.038), the mean duration of PD (58.1 months vs. 37.9 months, p = 0.032), and the weighted mean monthly EPO dose (1.22 μg/kg vs. 1.64 μg/kg, p = 0.009 ) were significantly higher in the subclinical hypothyroidism group than in the euthyroidism group, but the prevalences of coronary artery disease and cerebrovascular disease were not. From the multivariate model, PD duration was more significant than sex as a risk factor for subclinical hypothyroidism (p = 0.0132). ♦ Conclusions: Subclinical hypothyroidism is frequent in PD patients, especially female patients and patients with a longer PD duration. Compared with euthyroid patients, patients with subclinical hyperthyroidism need a higher dose of EPO to maintain a stable hemoglobin level.

Is an Isolated TSH Elevation in Chronic Nonthyroidal Illness “Subclinical Hypothyroidism”?

“…A high frequency of elevated TSH with normal total or free T 4 estimates is observed with chronic kidney diseases (1.6 to 28%) (3,4,10,11,34) and congestive heart failure (CHF) (6 to 16%), unrelated to medications known to induce thyroid gland failure (7, 42) (Table 2). In a small study of patients with chronic hepatic cirrhosis, 38% had elevated TSH by RIA and normal free T 4 by tracer equilibrium dialysis (43).…”

“…C riteria for diagnosing mild thyroid gland failure ("subclinical hypothyroidism") in the general population have been arbitrarily applied to patients with chronic nonthyroidal illnesses (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). Mild thyroid gland failure is defined as TSH levels persistently between 4.5 and 20 mU/L, with normal T 4 estimates, or progression to overt hypothyroidism (12)(13)(14)(15)).…”

The interaction between thyroid and kidney disease: an overview of the evidence

“…In US and Asian hemodialysis and peritoneal dialysis cohorts, the prevalence of hypothyroidism has ranged from 13 to 25%. [9, 12–14] Despite these data, hypothyroidism remains under-recognized in many advanced CKD patients, likely due to symptom overlap with uremia (e.g., fatigue, cold intolerance, decreased cognition). [1, 3]…”

Hypothyroidism and Mortality among Dialysis Patients

“…Patients with CKD and ESRD are more likely to manifest hypothyroidism than patients with preserved kidney function (1)(2)(3)(4)(5). Third National Health and Nutrition Examination Survey data indicate that the prevalence of hypothyroidism is 5.4%, 10.9%, 20.4%, 23.0%, and 23.1% among participants with estimated GFRs of $90, 60-89, 45-59, 30-44, and ,30 ml/min per 1.73 m 2 , respectively (4).…”