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Dell’Aquila M, Rossi CS, Caldonazo T, Cancelli G, Harik L, Soletti GJ, An KR, Leith J, Kirov H, Ibrahim M, Demetres M, Dimagli A, Rahouma M, Gaudino M. Subclinical hypothyroidism and clinical outcomes after cardiac surgery: A systematic review and meta-analysis. JTCVS OPEN 2024; 18:64-79. [PMID: 38690432 PMCID: PMC11056480 DOI: 10.1016/j.xjon.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/26/2024] [Accepted: 02/13/2024] [Indexed: 05/02/2024]
Abstract
Background Subclinical hypothyroidism (SCH) is associated with major adverse cardiovascular events. Despite the recognized negative impact of SCH on cardiovascular health, research on cardiac postoperative outcomes with SCH has yielded conflicting results, and patients are not currently treated for SCH before cardiac surgery procedures. Methods We performed a study-level meta-analysis on the impact of SCH on patients undergoing nonurgent cardiac surgery, including coronary artery bypass grafting and valve and aortic surgery. The primary outcome was operative mortality. Secondary outcomes were hospital length of stay (LOS), intensive care unit (ICU) stay, postoperative atrial fibrillation (POAF), intra-aortic balloon pump (IABP) use, renal complications, and long-term all-cause mortality. Results Seven observational studies, with a total of 3445 patients, including 851 [24.7%] diagnosed with SCH and 2594 [75.3%] euthyroid patients) were identified. Compared to euthyroid patients, the patients with SCH had higher rates of operative mortality (odds ratio [OR], 2.57; 95% confidence interval [CI], 1.09-6.04; P = .03), prolonged hospital LOS (standardized mean difference, 0.32; 95% CI, 0.02-0.62; P = .04), a higher rate of renal complications (OR, 2.53; 95% CI, 1.74-3.69; P < .0001), but no significant differences in ICU stay, POAF, or IABP use. At mean follow-up of 49.3 months, the presence of SCH was associated with a higher rate of all-cause mortality (incidence rate ratio, 1.82; 95% CI, 1.18-2.83; P = .02). Conclusions Patients with SCH have higher operative mortality, prolonged hospital LOS, and increased renal complications after cardiac surgery. Achieving and maintaining a euthyroid state prior to and after cardiac surgery procedures might improve outcomes in these patients.
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Affiliation(s)
| | - Camilla S. Rossi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Tulio Caldonazo
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
- Department of Cardiothoracic Surgery, Friedrich Schiller University, Jena, Germany
| | - Gianmarco Cancelli
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Lamia Harik
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | | | - Kevin R. An
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
- Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jordan Leith
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Hristo Kirov
- Department of Cardiothoracic Surgery, Friedrich Schiller University, Jena, Germany
| | - Mudathir Ibrahim
- Department of General Surgery, Maimonides Medical Center, Brooklyn, NY
| | - Michelle Demetres
- Samuel J. Wood Library & CV Starr Biomedical Information Center, Weill Cornell Medicine, New York, NY
| | - Arnaldo Dimagli
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Mohamed Rahouma
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
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2
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Darouei B, Amani-Beni R, Abhari AP, Fakhrolmobasheri M, Shafie D, Heidarpour M. Systematic review and meta-analysis of levothyroxine effect on blood pressure in patients with subclinical hypothyroidism. Curr Probl Cardiol 2024; 49:102204. [PMID: 37967804 DOI: 10.1016/j.cpcardiol.2023.102204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 11/11/2023] [Indexed: 11/17/2023]
Abstract
This study aims to evaluate the effect of levothyroxine therapy on blood pressure (BP) in patients with subclinical hypothyroidism (SCH). Were searched Six databases, and randomized controlled trials (RCT) and prospective cohort studies evaluating the effect of levothyroxine therapy on BP in patients with SCH were included. 37 articles (9 RCTs and 28 prospective cohorts) were included in this meta-analysis. Pooled analysis of RCT studies was insignificant; however, pooled analysis of 28 prospective cohort studies showed a significant difference before and after the therapy, reducing both systolic blood pressure (SBP) and diastolic blood pressure (DBP) (MD=-4.02 [-6.45, -4.58] and MD=-2.13 [-3.69, -0.56], both P-values<0.05). Levothyroxine therapy can play a role in lowering BP in patients with SCH. However, this effect is more observed in Caucasians, SCH patients with higher initial TSH followed by more remarkable TSH change to normal levels, and SCH patients with hypertension.
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Affiliation(s)
- Bahar Darouei
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reza Amani-Beni
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amir Parsa Abhari
- Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Fakhrolmobasheri
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Davood Shafie
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Heidarpour
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
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3
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Yu W, Wang Y, Ma L, Gou S, Fu P. Analysis of Thyroid Function in ANCA-Associated Vasculitis Patients with Renal Injury. J Pers Med 2024; 14:99. [PMID: 38248799 PMCID: PMC10817250 DOI: 10.3390/jpm14010099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/08/2024] [Accepted: 01/12/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Previous studies indicated common thyroid dysfunction in various kidney diseases. This study aimed to investigate the thyroid function in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV) with renal injury. METHODS Briefly, 174 patients diagnosed as having AAV with renal injury and without previous thyroid disease history were included in the retrospective and prospective study. The clinical parameters were collected and compared between different groups. RESULTS Of the patients included, 24 exhibited normal thyroid function, while 150 had thyroid dysfunction, including 55 (36.67%) with hypothyroidism. Those AAV patients with thyroid dysfunction showed different clinical parameters from those with normal thyroid function. The patients were followed up for a median of 68.6 (64.3; 72.8) months. Those with thyroid dysfunction were more prone to progressing to dialysis dependence compared to the group with normal thyroid function. Logistic regression analysis showed advanced age and decreased albumin as independent risk factors for thyroid dysfunction in patients with AAV. Survival analysis and multivariate Cox regression analysis showed that thyroid dysfunction was a risk factor for AAV patients with renal injury to progress to the endpoint of dialysis dependence. CONCLUSION Thyroid dysfunction, predominantly hypothyroidism, was commonly complicated in AAV patients with renal injury. AAV patients with thyroid dysfunction were presented with different clinical parameters and more prone to progressing to dialysis dependence compared to those with normal thyroid function.
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Affiliation(s)
- Wenhui Yu
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu 610041, China; (W.Y.); (L.M.); (P.F.)
| | - Yuelan Wang
- Renal Division, Department of Medicine, Chengdu Second People’s Hospital, Chengdu 610041, China;
| | - Liang Ma
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu 610041, China; (W.Y.); (L.M.); (P.F.)
| | - Shenju Gou
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu 610041, China; (W.Y.); (L.M.); (P.F.)
- Department of Nephrology, West China Tianfu Hospital of Sichuan University, Chengdu 610200, China
| | - Ping Fu
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu 610041, China; (W.Y.); (L.M.); (P.F.)
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4
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Griffin TP, Griffin MD. Thyroid Dysfunction and Chronic Kidney Disease: Unravelling the Connection. Mayo Clin Proc 2024; 99:7-9. [PMID: 38176835 DOI: 10.1016/j.mayocp.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 01/06/2024]
Affiliation(s)
- Tomás P Griffin
- Centre for Endocrinology, Diabetes Mellitus and Metabolism, Saolta University Health Care Group, Galway University Hospitals, Galway, Ireland; School of Medicine, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
| | - Matthew D Griffin
- Regenerative Medicine Institute (REMEDI) at CÚRAM SFI Research Centre for Medical Devices, College of Medicine, Nursing and Health Sciences, University of Galway, Ireland; Renal Services, Saolta University Health Care Group, Galway University Hospitals, Galway, Ireland.
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Kushwaha R, Vardhan PS, Kushwaha PP. Chronic Kidney Disease Interplay with Comorbidities and Carbohydrate Metabolism: A Review. Life (Basel) 2023; 14:13. [PMID: 38276262 PMCID: PMC10817500 DOI: 10.3390/life14010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/27/2024] Open
Abstract
Chronic kidney disease (CKD) poses a global health challenge, engendering various physiological and metabolic shifts that significantly impact health and escalate the susceptibility to severe illnesses. This comprehensive review delves into the intricate complexities of CKD, scrutinizing its influence on cellular growth homeostasis, hormonal equilibrium, wasting, malnutrition, and its interconnectedness with inflammation, oxidative stress, and cardiovascular diseases. Exploring the genetic, birth-related, and comorbidity factors associated with CKD, alongside considerations of metabolic disturbances, anemia, and malnutrition, the review elucidates how CKD orchestrates cellular growth control. A pivotal focus lies on the nexus between CKD and insulin resistance, where debates persist regarding its chronological relationship with impaired kidney function. The prevalence of insulin abnormalities in CKD is emphasized, contributing to glucose intolerance and raising questions about its role as a precursor or consequence. Moreover, the review sheds light on disruptions in the growth hormone and insulin-like growth factor axis in CKD, underscoring the heightened vulnerability to illness and mortality in cases of severe growth retardation. Wasting, a prevalent concern affecting up to 75% of end-stage renal disease (ESRD) patients, is analyzed, elucidating the manifestations of cachexia and its impact on appetite, energy expenditure, and protein reserves. Taste disturbances in CKD, affecting sour, umami, and salty tastes, are explored for their implications on food palatability and nutritional status. Independent of age and gender, these taste alterations have the potential to sway dietary choices, further complicating the management of CKD. The intricate interplay between CKD, inflammation, oxidative stress, and cardiovascular diseases is unraveled, emphasizing the profound repercussions on overall health. Additionally, the review extends its analysis to CKD's broader impact on cognitive function, emotional well-being, taste perception, and endothelial dysfunction. Concluding with an emphasis on dietary interventions as crucial components in CKD management, this comprehensive review navigates the multifaceted dimensions of CKD, providing a nuanced understanding essential for developing targeted therapeutic strategies.
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Affiliation(s)
- Radha Kushwaha
- Centre of Food Technology, University of Allahabad, Allahabad 211002, Uttar Pradesh, India;
| | - Pothabathula Seshu Vardhan
- Department of Chemistry, Sardar Vallabhbhai National Institute of Technology (SVNIT), Surat 395007, Gujarat, India;
| | - Prem Prakash Kushwaha
- Department of Biological, Geological, and Environmental Sciences, Cleveland State University, Cleveland, OH 44115, USA
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Prasad N, Singh S, Kumar V, Sahay M, Chaudhury AR, Behera MR, Kushwaha RS, Yadav D, Gautam S, Jaiswal A. Protocol and Methods: Role of Levothyroxine on the Progression of Chronic Kidney Disease in Subclinical Hypothyroid Populations (LP-CKD) - A Multicenter Randomized Controlled Trial. Indian J Nephrol 2023; 33:449-455. [PMID: 38174306 PMCID: PMC10752393 DOI: 10.4103/ijn.ijn_188_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/05/2022] [Accepted: 11/09/2022] [Indexed: 07/19/2023] Open
Abstract
Introduction Subclinical hypothyroidism (SCH) is highly prevalent and associated with chronic kidney disease (CKD). However, it is still unanswered whether the restoration of euthyroid status in these patients will be beneficial in retarding a decline in glomerular filtration rate in early CKD patients. We aim to evaluate the efficacy of levothyroxine therapy versus placebo in slowing estimated glomerular filtration rate (eGFR) decline among CKD patients (stage 2-4) with SCH. Methods This study will be a multicentric, double-blind, randomized, parallel-group, placebo-controlled study. A total of 500 CKD patients, 250 patients in the treatment group and 250 patients in the placebo group, will be randomized. The randomization between the treatment arm and placebo arm will be performed as per the computer-generated random number table in a 1:1 ratio. The sample size was calculated based on the assumed reduction in eGFR after 1-year follow-up in the treatment and placebo groups of 10% and 25%, respectively, at a minimum two-sided 99% confidence interval and 90% power of the study and considering 20% loss on follow-up. Each patient will be followed every 3 months for at least 1 year after randomization. Individuals completing 1-year follow-up visits will be considered for analysis. The baseline and follow-up data will be compared between the treatment and placebo groups. The study will evaluate the efficacy and safety of levothyroxine therapy versus placebo in slowing eGFR decline among CKD patients (stage 2-4) with SCH. The primary endpoint will be the end of follow-up of the patients, reduction of eGFR by ≥50% from a baseline of that patient, or development of ESKD or death of the patients. The secondary endpoint will be any cardiovascular event or arrhythmia after the institution of the drug.
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Affiliation(s)
- Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Shivendra Singh
- Institute of Medical Science, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Vivek Kumar
- Institute of Medical Education and Research, Chandigarh, India
| | - Manisha Sahay
- Osmania Medical College, Osmania General Hospital, Hyderabad, Telangana, India
| | | | - Manas Ranjan Behera
- Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Ravi Shankar Kushwaha
- Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Deependra Yadav
- Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Sonam Gautam
- Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Akhilesh Jaiswal
- Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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7
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Lo R, Narasaki Y, Lei S, Rhee CM. Management of traditional risk factors for the development and progression of chronic kidney disease. Clin Kidney J 2023; 16:1737-1750. [PMID: 37915906 PMCID: PMC10616454 DOI: 10.1093/ckj/sfad101] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Indexed: 11/03/2023] Open
Abstract
Chronic kidney disease (CKD) and its downstream complications (i.e. cardiovascular) are a major source of morbidity worldwide. Additionally, deaths due to CKD or CKD-attributable cardiovascular disease account for a sizeable proportion of global mortality. However, the advent of new pharmacotherapies, diagnostic tools, and global initiatives are directing greater attention to kidney health in the public health agenda, including the implementation of effective strategies that (i) prevent kidney disease, (ii) provide early CKD detection, and (iii) ameliorate CKD progression and its related complications. In this Review, we discuss major risk factors for incident CKD and CKD progression categorized across cardiovascular (i.e. hypertension, dyslipidemia, cardiorenal syndrome), endocrine (i.e. diabetes mellitus, hypothyroidism, testosterone), lifestyle (i.e. obesity, dietary factors, smoking), and genetic/environmental (i.e. CKDu/Mesoamerican nephropathy, APOL1, herbal nephropathy) domains, as well as scope, mechanistic underpinnings, and management.
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Affiliation(s)
- Robin Lo
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, CA, USA
| | - Yoko Narasaki
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, CA, USA
- Tibor Rubin Veterans Affairs Medical Center, Long Beach, CA, USA
| | - Sean Lei
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, CA, USA
| | - Connie M Rhee
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, CA, USA
- Tibor Rubin Veterans Affairs Medical Center, Long Beach, CA, USA
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8
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Copur S, Demiray A, Basile C, Kanbay M. Endocrinological disorders in acute kidney injury: an often overlooked field of clinical research. J Nephrol 2023; 36:885-893. [PMID: 36652168 DOI: 10.1007/s40620-022-01554-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/05/2022] [Indexed: 01/19/2023]
Abstract
Acute kidney injury (AKI) is a common comorbidity, affecting approximately one in five hospitalized adults. The kidney is the site for the production, metabolism or excretion of most hormones, including the production of erythropoietin (EPO), the active form of vitamin D, renin, thrombopoietin, and the excretion of insulin, catecholamines, gastrin and many other hormones. Therefore, it is reasonable to say that AKI can have a considerable impact on the endocrine system. Although the effects of AKI on various parameters, including cardiovascular parameters, serum electrolytes and acid-base disorders, neuro-humoral mechanisms and neurological outcomes have been extensively studied, the endocrinological consequences of AKI are understudied. Thyroid dysfunction, mainly euthyroid sick syndrome, hypo/hyperglycemia, bone mineral disorders, changes in EPO and atrial natriuretic peptide (ANP) levels are commonly found in AKI. EPO, thyroxine and ANP administration have been evaluated as potential tools to prevent or treat AKI with varying success, while the effects of AKI on some key hormones, including cortisol and insulin, have never been studied. Aim of this narrative review is to illustrate what is known and what is not known about the endocrinological outcomes of AKI. Few clinical trials are ongoing: however, there is a clear need for large-scale randomized controlled trials investigating the endocrinological consequences of AKI.
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Affiliation(s)
- Sidar Copur
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Atalay Demiray
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Carlo Basile
- Associazione Nefrologica Gabriella Sebastio, Martina Franca, Italy.
| | - Mehmet Kanbay
- Department of Medicine, Division of Nephrology, Koc University School of Medicine, Istanbul, Turkey
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9
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Zhang C, Qian C, Wang W, Chen Z, Lin Y, Sun M. AIDS with obesity, hypothyroidism and elevated serum creatinine: A case report. Front Med (Lausanne) 2023; 10:1090659. [PMID: 36999076 PMCID: PMC10043362 DOI: 10.3389/fmed.2023.1090659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 02/24/2023] [Indexed: 03/15/2023] Open
Abstract
Hypothyroidism is a prevalent endocrine illness with a variety of clinical symptoms, but among which elevated serum creatinine is uncommon. Hypothyroidism is also common in acquired immunodeficiency syndrome (AIDS) patients, especially those receiving highly active antiretroviral treatment (HAART). Here we present a case of a young AIDS patient with hypothyroidism, increased serum creatinine, and obesity. Despite the lack of a kidney biopsy, following levothyroxine (LT4) therapy, his serum creatinine recovered to normal levels, and weight loss, edema, weakness, rough skin and other clinical symptoms obtained notable improvement. This highlights the need of clinicians paying attention to whether thyroid function is aberrant in human immunodeficiency virus (HIV) patients with increased creatinine, edema and significant weight gain since prompt thyroid hormone therapy can restore the alterations in renal function and avoid invasive renal biopsy.
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10
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Kidney disease and thyroid dysfunction: the chicken or egg problem. Pediatr Nephrol 2022; 37:3031-3042. [PMID: 35737115 DOI: 10.1007/s00467-022-05640-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/04/2022] [Accepted: 05/19/2022] [Indexed: 01/10/2023]
Abstract
Patients with non-dialysis-dependant chronic kidney disease (NDD-CKD) and dialysis-dependant chronic kidney disease (DD-CKD) frequently also suffer from thyroid disorders, especially hypothyroidism which is found two to five times more often among them compared to the general population. Emerging research has illustrated the potential prognostic implications of this association as NDD-CKD and DD-CKD patients with hypothyroidism have been shown to have higher mortality rates, and treatment of subclinical hypothyroidism in NDD-CKD patients has been reported to attenuate the decline of glomerular filtration rate over time. This review illustrates the bidirectional, multi-layered interplay between the kidneys and the thyroid gland explaining how pathologies in one organ will affect the other and vice versa. Additionally, it outlines the impact of thyroid disorders on routine parameters of kidney function (especially serum creatinine and serum cystatin C) that nephrologists should be aware of in their clinical practice. Lastly, it summarizes the emerging evidence from clinical studies on how treatment of subclinical hypothyroidism in NDD-CKD and DD-CKD patients may potentially have beneficial effects on kidney function as well as mortality. While most of the research in this area has been performed on adult patients, we specifically discuss what is currently known about thyroid dysfunctions in paediatric CKD patients as well and provide management suggestions. The evidence accumulated so far clearly indicates that further, prospective studies with meticulous methodology are warranted to refine our understanding of thyroid disorders in paediatric and adult CKD patients and establish optimal treatment pathways.
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11
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Kotsopoulou I, Vyas AK, Cory MJ, Chan CS, Jagarapu J, Gill S, Mudduluru M, Angelis D. Developmental changes of the fetal and neonatal thyroid gland and functional consequences on the cardiovascular system. J Perinatol 2022; 42:1576-1586. [PMID: 36376450 DOI: 10.1038/s41372-022-01559-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/29/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022]
Abstract
Thyroid hormones play an important role in the development and function of the cardiac myocyte. Dysregulation of the thyroid hormone milieu affects the fetal cardiac cells via complex molecular mechanisms, either by altering gene expression or directly by affecting post-translational processes. This review offers a comprehensive summary of the effects of thyroid hormones on the developing cardiovascular system and its adaptation. Furthermore, we will highlight the gaps in knowledge and provide suggestions for future research.
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Affiliation(s)
- Ioanna Kotsopoulou
- Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Arpita K Vyas
- Division of Pediatrics and Endocrinology, College of Medicine, California Northstate University, Elk Grove, CA, USA
| | - Melinda J Cory
- Division of Cardiology, Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Christina S Chan
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jawahar Jagarapu
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Shamaila Gill
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Manjula Mudduluru
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Dimitrios Angelis
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, TX, USA.
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12
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Matsuoka-Uchiyama N, Tsuji K, Sang Y, Takahashi K, Fukushima K, Takeuchi H, Inagaki K, Uchida HA, Kitamura S, Sugiyama H, Wada J. The association between hypothyroidism and proteinuria in patients with chronic kidney disease: a cross-sectional study. Sci Rep 2022; 12:14999. [PMID: 36056164 PMCID: PMC9440240 DOI: 10.1038/s41598-022-19226-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 08/25/2022] [Indexed: 12/27/2022] Open
Abstract
Hypothyroidism is known to be correlated with kidney function and nephrotic range proteinuria. However, it is uncertain whether non-nephrotic proteinuria is associated with hypothyroidism. This study aimed to evaluate the association of proteinuria and hypothyroidism in chronic kidney disease (CKD) patients. We conducted a cross-sectional study composed of 421 CKD patients in a single hospital with measurements of 24-h urine protein excretion (UP) and thyroid function tests. Spearman correlation analysis revealed that 24-h Cr clearance (24hrCcr) was positively (r = 0.273, p < 0.001) and UP was negatively (r = - 0.207, p < 0.001) correlated with free triiodothyronine. Frequency distribution analysis stratified by CKD stage and UP for hypothyroidism revealed that the prevalence of hypothyroidism was higher among participants with higher CKD stage and nephrotic range proteinuria. Multivariate logistic regression analysis revealed that 24hrCcr and UP were significantly correlated with hypothyroidism (24hrCcr/10 mL/min decrease: odds ratio [OR], 1.29; 95% confidence interval [CI], 1.18-1.41; UP/1 g increase: OR, 1.10; 95% CI, 1.03-1.17). In addition, nephrotic range proteinuria, but not moderate UP (UP: 1.5-3.49 g/day), was significantly correlated with hypothyroidism compared to UP < 0.5 g/day. In summary, decreased kidney function and nephrotic range proteinuria, not non-nephrotic proteinuria, are independently associated with the hypothyroidism.
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Affiliation(s)
- Natsumi Matsuoka-Uchiyama
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan
| | - Kenji Tsuji
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan.
| | - Yizhen Sang
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan
| | - Kensaku Takahashi
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan
| | - Kazuhiko Fukushima
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan
| | - Hidemi Takeuchi
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan
| | - Kenichi Inagaki
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan
| | - Haruhito A Uchida
- Department of Chronic Kidney Disease and Cardiovascular Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Shinji Kitamura
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan
| | - Hitoshi Sugiyama
- Department of Human Resource Development of Dialysis Therapy for Kidney Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Jun Wada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan
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Yu L, Lacorcia L, Johnstone T. Hyperthyroid cats and their kidneys: a literature review. Aust Vet J 2022; 100:415-432. [PMID: 35711100 PMCID: PMC9543258 DOI: 10.1111/avj.13179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/28/2022] [Accepted: 05/01/2022] [Indexed: 11/28/2022]
Abstract
Hyperthyroidism and chronic kidney disease (CKD) are common diseases of geriatric cats, and often occur concurrently. Thus, a thorough understanding of the influence of thyroid function on renal function is of significant value for all feline practitioners. Among other effects, hyperthyroidism causes protein catabolism and increases renal blood flow and glomerular filtration rate (GFR). These effects render traditional renal markers insensitive for the detection of CKD in cats with uncontrolled hyperthyroidism. Furthermore, the development of iatrogenic hypothyroidism with over treatment of hyperthyroidism can be detrimental to renal function and may negatively affect long-term survival. This review discusses important diagnostic considerations of feline hyperthyroidism, as well as key treatment modalities, with an emphasis on the use of radioiodine and the importance of post treatment monitoring of thyroid and renal parameters. In Australia, a common curative treatment for cats with benign hyperthyroidism (i.e. thyroid hyperplasia or adenoma) is a fixed dose of orally administered radioiodine, regardless of the serum total thyroxine concentration at the time of diagnosis. This review discusses the long term outcomes of this standard of care in comparison with current, relevant research literature from around the world. Finally, this review explores the use of symmetric dimethylarginine (SDMA) in assessing renal function before and after treatment in hyperthyroid cats. SDMA correlates well with GFR and creatinine in non-hyperthyroid cats, but our understanding of its performance in hyperthyroid cats remains in its infancy.
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Affiliation(s)
- L Yu
- Veterinary Referral HospitalDandenongVictoriaAustralia
| | - L Lacorcia
- Veterinary Referral HospitalDandenongVictoriaAustralia
| | - T Johnstone
- Animal Referral Hospital, Essendon Fields72 Hargrave AvenueEssendon FieldsVictoria3041Australia
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14
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Iqbal S, Wan WY, Mitchell NE. It’s Not Lupus This Time! A Case of Worsening Hypothyroidism in a Patient With Nephrotic Syndrome. Cureus 2022; 14:e25355. [PMID: 35761923 PMCID: PMC9233522 DOI: 10.7759/cureus.25355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2022] [Indexed: 11/17/2022] Open
Abstract
Nephrotic syndrome can result in worsening of existing hypothyroidism in patients requiring thyroid hormone supplementation. The urinary loss of thyroxine-binding globulin, as well as increased gut edema, likely lead to reduced absorption and retention of exogenous thyroid hormone. Here, we present a case of a patient with Hashimoto’s thyroiditis, previously well-controlled on levothyroxine, who developed symptomatic hypothyroidism as a result of newly diagnosed nephrotic syndrome, whose symptoms improved with transition to an alternative formulation of levothyroxine and treatment of her underlying nephrotic syndrome. It is important to consider nephrotic syndrome as a cause of worsening hypothyroidism in a patient on a fixed dose of levothyroxine given the potential morbidity associated with a missed diagnosis and often need for escalation of dosage. There is no standardized therapy for hypothyroidism exacerbated by nephrotic syndrome, but liquid or gel formulations of levothyroxine may be more effective in patients with absorption problems.
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15
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Shazley O, Shazley A, Alshazley M. Acute Bacterial Hemorrhagic Pyelonephritis in a COVID-19 Patient With a History of Hypothyroidism: A Case Report. Cureus 2022; 14:e21730. [PMID: 35251803 PMCID: PMC8887623 DOI: 10.7759/cureus.21730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2022] [Indexed: 11/20/2022] Open
Abstract
Since its initial reporting in December 2019, the novel coronavirus SARS-CoV-2 has emerged as a global health problem after its official declaration as a pandemic by the World Health Organization, with an estimated 346 million cases and over 5.9 million fatalities as of January 22, 2022. Studies on the prevalence of COVID-19 among severe cases have shown that comorbidities and risk factors such as obesity, increased aging, and chronic cardiovascular and respiratory diseases play a role in the severity of SARS-CoV-2 infections. The interactions between such factors and their involvement with the progression of infection and mortality remain unclear. While it is known that SARS-CoV-2 damages the lungs, various morbidities such as acute kidney disease and thyroid dysregulation have recently emerged in symptomatic COVID-19 patients. Conditions that alter thyroid hormones, which play a critical role in regulating metabolic pathways, have a role in the level of infectivity of the SARS-CoV-2. The capability of the SARS-CoV-2 to invade and affect any organ system is dependent on its access to the angiotensin-converting enzyme II (ACE2) commonly expressed among various host cells. This binding puts any system at high risk of direct viral injury, inevitably creating an excessively high concentration of anti-inflammatory mediators and cytokines to predispose COVID-19 patients to a state of severe immunosuppression. This case report describes a 62-year-old female who tested positive for COVID-19, with a medical history of hypothyroidism, who presented with a unique combination of acute bacterial hemorrhagic pyelonephritis and ureteral obstruction. She experienced intermittent dysuria, urinary urgency, and hematuria over the past five days. She developed chills, diaphoresis, nausea, and vomiting after administering acetaminophen for her headache. Ageusia and anosmia accompanied her respiratory illnesses despite receiving the Pfizer double dose vaccine six months before her arrival. A computerized tomography (CT) scan revealed severe to moderate inflammation surrounding the enlarged kidney with a 1 mm ureteral stone. Blood and urine cultures showed the growth of Escherichia coli gram-negative bacilli. Chest X-rays displayed a patchy appearance in the right infrahilar airspace, reflecting atelectasis in part for the diagnosis of COVID-19 with additional laboratory findings of profoundly elevated C-reactive protein, fibrinogen, and d-dimer levels. Abdominal CT scans revealed a hemorrhagic ureteral obstruction and massive swelling of the renal parenchyma persistent to pyelonephritis and hydronephrosis.
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Affiliation(s)
- Omar Shazley
- Basic Sciences, Saint James School of Medicine, Park Ridge, USA
| | - Ameer Shazley
- Basic Sciences, Saint James School of Medicine, Park Ridge, USA
| | - Moudar Alshazley
- Emergency Medicine, Internal Medicine, Santa Rosa Medical Center, Pensacola, USA
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16
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Yang Z, Duan P, Li W, Nie R, Lou X, Wang L, Wu K, Liu J, Tu P, Lai X. The Correlation between Thyroid Hormone Levels and the Kidney Disease Progression Risk in Patients with Type 2 Diabetes. Diabetes Metab Syndr Obes 2022; 15:59-67. [PMID: 35023940 PMCID: PMC8743497 DOI: 10.2147/dmso.s347862] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 12/15/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE We investigated the relationship between thyroid hormones and the risk of diabetic kidney disease (DKD) progression. METHODS A total of 452 patients with type 2 diabetes were included, and a cross-sectional analysis was performed. Urine albumin/creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR) were used to diagnose persistent albuminuria and stage chronic kidney disease, respectively. The Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guideline was used to describe the risk of DKD progression (low, moderate, and high or very high risks). RESULTS The DKD group had higher levels of thyroid-stimulating hormone (TSH) and lower levels of free triiodothyronine (FT3) and free thyroxine (FT4) than the non-DKD group. The prevalence of thyroid dysfunction in the DKD group was significantly higher than in the non-DKD group, especially the prevalence of subclinical hypothyroidism. FT3 levels decreased gradually with the deterioration of DKD. TSH levels increased with an increasing KDIGO category. FT3 and FT4 levels were negatively correlated with serum creatinine levels and ACR, and positively correlated with eGFR. Contrastingly, TSH was positively correlated with ACR, and negatively correlated with eGFR. After adjustment, an increase in FT3 levels significantly reduced the risk of DKD [odds ratio, OR (95% confidence interval, CI)=0.58 (0.42-0.79)] and DKD progression [ORs (95% CIs)=0.65 (0.45-0.93) for the moderate risk group and 0.50 (0.33-0.74) for the high or very high-risk group, using the low-risk group as a reference]. FT3 levels below 4.30 pmol/L in men and 3.99 pmol/L in women were the cut-off points for an increased risk of DKD progression. CONCLUSION Low FT3 level is an independent risk factor for DKD and DKD progression. FT3 ≤4.30 pmol/L in men and ≤3.99 pmol/L in women will greatly increase the risk of kidney disease progression in patients with type 2 diabetes.
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Affiliation(s)
- Zhi Yang
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Nanchang University, Nanchang, 330008, Jiangxi, People’s Republic of China
- Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang, 330000, Jiangxi, People’s Republic of China
- Jiangxi Medical College of Nanchang University, Nanchang, 330036, Jiangxi, People’s Republic of China
| | - Peng Duan
- Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang, 330000, Jiangxi, People’s Republic of China
| | - Weihong Li
- Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang, 330000, Jiangxi, People’s Republic of China
| | - Ronghui Nie
- Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang, 330000, Jiangxi, People’s Republic of China
- Jiangxi Medical College of Nanchang University, Nanchang, 330036, Jiangxi, People’s Republic of China
| | - Xiaoyang Lou
- Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang, 330000, Jiangxi, People’s Republic of China
- Jiangxi University of Traditional Chinese Medicine, Nanchang, 330004, Jiangxi, People’s Republic of China
| | - Lina Wang
- Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang, 330000, Jiangxi, People’s Republic of China
| | - Kexia Wu
- Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang, 330000, Jiangxi, People’s Republic of China
| | - Jiang Liu
- Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang, 330000, Jiangxi, People’s Republic of China
| | - Ping Tu
- Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang, 330000, Jiangxi, People’s Republic of China
| | - Xiaoyang Lai
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Nanchang University, Nanchang, 330008, Jiangxi, People’s Republic of China
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17
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Zhang L, Wu Y, Nie Y, Lv W, Li Y, Zhu B, Jin S, Shen Z, Li F, Liu H, Fang Y, Ding X. 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. Front Endocrinol (Lausanne) 2022; 13:977355. [PMID: 36246924 PMCID: PMC9556952 DOI: 10.3389/fendo.2022.977355] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/12/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Crescent 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. METHODS This 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. RESULTS The 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). CONCLUSIONS A low FT3/FT4 ratio is associated with increased mortality and worse outcome risk in CKD patients with crescent pathology.
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Affiliation(s)
- Liwen Zhang
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Kidney and Dialysis, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Medical Center of Kidney, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Kidney and Blood Purification, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuxiao Wu
- Department of Internal Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuxin Nie
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Kidney and Dialysis, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Medical Center of Kidney, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Kidney and Blood Purification, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wenlv Lv
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Kidney and Dialysis, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Medical Center of Kidney, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Kidney and Blood Purification, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yang Li
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Kidney and Dialysis, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Medical Center of Kidney, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Kidney and Blood Purification, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Bowen Zhu
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Kidney and Dialysis, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Medical Center of Kidney, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Kidney and Blood Purification, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shi Jin
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Kidney and Dialysis, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Medical Center of Kidney, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Kidney and Blood Purification, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ziyan Shen
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Kidney and Dialysis, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Medical Center of Kidney, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Kidney and Blood Purification, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Fang Li
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Kidney and Dialysis, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Medical Center of Kidney, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Kidney and Blood Purification, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hong Liu
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Kidney and Dialysis, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Medical Center of Kidney, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Kidney and Blood Purification, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yi Fang
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Kidney and Dialysis, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Medical Center of Kidney, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Kidney and Blood Purification, Zhongshan Hospital, Fudan University, Shanghai, China
- *Correspondence: Yi Fang, ; Xiaoqiang Ding,
| | - Xiaoqiang Ding
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Kidney and Dialysis, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Medical Center of Kidney, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Kidney and Blood Purification, Zhongshan Hospital, Fudan University, Shanghai, China
- *Correspondence: Yi Fang, ; Xiaoqiang Ding,
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Ostróżka-Cieślik A, Dolińska B, Ryszka F. Effectiveness Assessment of a Modified Preservation Solution Containing Thyrotropin or Follitropin Based on Biochemical Analysis in Perfundates and Homogenates of Isolated Porcine Kidneys after Static Cold Storage. Int J Mol Sci 2021; 22:ijms22168360. [PMID: 34445068 PMCID: PMC8395071 DOI: 10.3390/ijms22168360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/29/2021] [Accepted: 07/31/2021] [Indexed: 12/15/2022] Open
Abstract
In this paper, we assess the nephroprotective effects of thyrotropin and follitropin during ischaemia. The studies were performed in vitro in a model of isolated porcine kidneys stored in Biolasol (FZNP, Biochefa, Sosnowiec, Poland) and modified Biolasol (TSH: 1 µg/L; FSH 1 µg/L). We used the static cold storage method. The study was carried out based on 30 kidneys. The kidneys were placed in 500 mL of preservation solution chilled to 4 °C. The samples for biochemical tests were collected during the first kidney perfusion (after 2 h of storage) and during the second perfusion (after 48 h of storage). The results of ALT, AST, and LDH activities confirm the effectiveness of Biolasol + p-TSH in maintaining the structural integrity of renal cell membranes. Significantly reduced biochemical parameters of kidney function, i.e., creatinine and protein concentrations were also observed after 48 h storage. The protective effect of Biasol + p-TSH is most pronounced after 2 h of storage, suggesting a mild course of damage thereafter. A mild deterioration of renal function was observed after 48 h. The results of our analyses did not show any protective effect of Biolasol + p-FSH on the kidneys during ischaemia.
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Affiliation(s)
- Aneta Ostróżka-Cieślik
- Department of Pharmaceutical Technology, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Kasztanowa 3, 41-200 Sosnowiec, Poland;
- Correspondence:
| | - Barbara Dolińska
- Department of Pharmaceutical Technology, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Kasztanowa 3, 41-200 Sosnowiec, Poland;
- “Biochefa” Pharmaceutical Research and Production Plant, Kasztanowa 3, 41-200 Sosnowiec, Poland;
| | - Florian Ryszka
- “Biochefa” Pharmaceutical Research and Production Plant, Kasztanowa 3, 41-200 Sosnowiec, Poland;
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Tsuda S, Nakayama M, Matsukuma Y, Yoshitomi R, Haruyama N, Fukui A, Nakano T, Tsuruya K, Kitazono T. Subclinical hypothyroidism is independently associated with poor renal outcomes in patients with chronic kidney disease. Endocrine 2021; 73:141-150. [PMID: 33474711 DOI: 10.1007/s12020-021-02611-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/05/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE It remains unclear whether subclinical hypothyroidism (SCH) is associated with renal prognosis in patients with chronic kidney disease (CKD). Therefore, we prospectively investigated the association of SCH with renal outcomes in CKD. METHODS We conducted a prospective observational study of 480 euthyroid patients and 89 patients with SCH. The endpoints were defined as a composite of doubling of serum creatinine (SCr), end-stage renal disease (ESRD), or death, and a composite of doubling of SCr or ESRD was added as an alternative outcome. Logistic regression analyses were used to identify the factors associated with SCH. In addition, a Cox proportional hazards model was performed to determine whether SCH was associated with poor renal outcomes. RESULTS During a median follow-up period of 26.1 months, doubling of SCr, ESRD, or death and doubling of SCr or ESRD occurred in 244 and 213 patients, respectively. In univariable logistic regression analyses, SCH was significantly associated with older age, lower hemoglobin, higher proteinuria, lower estimated glomerular filtration rate (eGFR), and higher log B-type natriuretic peptide (BNP). Multivariable Cox analyses showed that SCH was associated with poorer renal outcomes after adjustment for covariates, including eGFR and log BNP [doubling of SCr, ESRD, or death: hazard ratio (HR) 1.61, 95% confidence interval (CI), 1.16-2.23; doubling of SCr or ESRD: HR 1.53, 95% CI 1.07-2.20], compared with euthyroidism. CONCLUSIONS In CKD, SCH is independently associated with poor renal outcomes, suggesting that screening for SCH might be needed to accurately predict renal prognosis.
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Affiliation(s)
- Susumu Tsuda
- Division of Nephrology and Clinical Research Institute, Department of Internal Medicine, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka, 810-8563, Japan
| | - Masaru Nakayama
- Division of Nephrology and Clinical Research Institute, Department of Internal Medicine, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka, 810-8563, Japan.
| | - Yuta Matsukuma
- Division of Nephrology and Clinical Research Institute, Department of Internal Medicine, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka, 810-8563, Japan
| | - Ryota Yoshitomi
- Division of Nephrology and Clinical Research Institute, Department of Internal Medicine, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka, 810-8563, Japan
| | - Naoki Haruyama
- Division of Nephrology and Clinical Research Institute, Department of Internal Medicine, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka, 810-8563, Japan
| | - Akiko Fukui
- Division of Nephrology and Clinical Research Institute, Department of Internal Medicine, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka, 810-8563, Japan
| | - Toshiaki Nakano
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kazuhiko Tsuruya
- Department of Nephrology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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20
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Povidone Iodine Disinfection Associated with Hypothyroidism and Potentially Contributing to Prolonged Kidney Failure. Case Rep Crit Care 2021; 2021:5528210. [PMID: 34258074 PMCID: PMC8253621 DOI: 10.1155/2021/5528210] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/22/2021] [Indexed: 11/21/2022] Open
Abstract
Objectives To report a case of povidone-iodine (PVP-I, Iso-Betadine®) disinfection of lower leg fasciotomy wounds resulting in iodide absorption and possibly contributing to hypothyroidism and prolonged kidney injury. Design Case report. Setting. Pediatric intensive care unit (PICU), university hospital. Patients. A 13-year-old patient presenting with prolonged oligoanuric kidney failure and unexplained primary hypothyroidism three weeks after severe abdominal sepsis with multiple organ dysfunction and major rhabdomyolysis due to bilateral lower leg compartment syndrome, necessitating moderate size fasciotomies, disinfected daily with PVP-I. Interventions. Interruption of PVP-I exposure and initiation of thyroid hormone substitution. Measurements and Main Results. Hypothyroidism was revealed during diagnostic work-up for persistent hypertriglyceridemia. Thyroxine (T4) (4.0 mg/L) and tri-iodothyronine (T3) (64 ng/L) were moderately low, yet thyroid stimulating hormone (TSH) (16.8 mIU/L) was fourfold the maximal normal range value. This pattern, atypical for prolonged critical illness-related hypothyroidism, prompted interruption of PVP-I exposure and initiation of thyroid hormone substitution. Urinary production and creatinine clearance recovered during the following days, and one week later, intermittent renal replacement therapy could be terminated, suggesting that PVP-I toxicity and/or hypothyroidism may have contributed to the persistent renal failure three weeks after resolved septic shock and rhabdomyolysis. Elevated serum and urinary anion gap normalized simultaneously, but this evolution of rather nonspecific indices could be multifactorial. Conclusion PVP-I is a commonly used broad-spectrum antimicrobial agent for prevention and treatment of wound infections. Toxic complications due to PVP-I absorption, after disinfection of extended thermal injuries larger than 20% of the body surface, have been described. In critically ill children, however, toxic effects of PVP-I may occur due to repeated disinfection of less extended wounds. Proposed screening strategies include: monitoring of the volumes of PVP-I applied daily; of the thyroid function, the serum, and/or urinary anion gap and the urinary iodide concentrations. These strategies, however, remain to be validated. This case report should be a wake-up call for daily integration of wound management in the clinical evaluation of critically ill patients.
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21
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Kalra S, Aggarwal S, Khandelwal D. Thyroid Dysfunction and Dysmetabolic Syndrome: The Need for Enhanced Thyrovigilance Strategies. Int J Endocrinol 2021; 2021:9641846. [PMID: 33859689 PMCID: PMC8024090 DOI: 10.1155/2021/9641846] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 02/26/2021] [Accepted: 03/19/2021] [Indexed: 12/25/2022] Open
Abstract
Thyroid dysfunction (TD) is common in metabolic disorders such as diabetes mellitus (DM), cardiovascular disease (CVD), obesity, dyslipidemia, hyperuricemia, kidney and liver dysfunctions, and polycystic ovary syndrome (PCOS). Subclinical hypothyroidism (SHypo) worsens glycemic control in patients with DM, and these patients, especially those with Type-1DM, have higher prevalence of TD. Both TD and DM increase CVD risk. Even minor alteration in thyroid hormone (TH) levels can alter cardiovascular function. While hyperthyroidism increases systolic blood pressure and leads to high-output heart failure, hypothyroidism increases diastolic blood pressure and leads to low-output heart failure. Chronic subclinical hyperthyroidism (SHyper) and SHypo both increase the risk of hypertension, coronary artery disease (CAD) events, CAD deaths, and total deaths. SHyper alters cardiac morphology and function. SHypo causes dyslipidemia and endothelial dysfunction and increases the risk for weight gain and obesity. Overweight and obese patients often have hyperleptinemia, which increases the secretion of thyroid stimulating hormone (TSH) and induces TD. Dyslipidemia associated with TD can increase serum uric acid levels. Hyperuricemia promotes inflammation and may increase the risk for dyslipidemia, atherosclerosis, and CVD. TD increases the risk for developing chronic kidney disease. In nephrotic syndrome, proteinuria is associated with urinary loss of TH leading to TD. Some correlation between TD and severity of liver disease is also seen. TD and PCOS have common risk factors and pathophysiological abnormalities. Hypothyroidism must be excluded before diagnosing PCOS. Current guidelines do not strongly recommend thyroid screening in the presence of all metabolic disorders. However, pragmatic thyrovigilance is required. Clinicians must stay alert to signs and symptoms of TD, maintain high clinical suspicion, and investigate thoroughly. Drug-induced TD should be considered when TH levels do not match clinical findings or when patients are on medications that can alter thyroid function.
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Peters J, Roumeliotis S, Mertens PR, Liakopoulos V. Thyroid hormone status in patients with impaired kidney function. Int Urol Nephrol 2021; 53:2349-2358. [PMID: 33682051 DOI: 10.1007/s11255-021-02800-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 02/08/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE We aimed to investigate the prevalence of thyroid hormone abnormalities and the relationship between free triiodothyronine (fT3), thyroid stimulating hormone (TSH) and free thyroxine (fT4) serum levels with kidney function and proteinuria in 4108 subsequent patients admitted to a Nephrology Clinic at a tertiary Medical Centre. METHODS All patients were categorized based on their estimated glomerular filtration rate (eGFR) as follows: normal-eGFR ≥ 60 ml/min, mild kidney impairment-30 ≤ eGFR < 60 ml/min, and severe kidney impairment-eGFR < 30 ml/min. RESULTS Subjects with normal eGFR presented a laboratory constellation of hypothyroidism in 3.38% and "low-T3 syndrome" in 8.28%, while subjects with severe kidney impairment were diagnosed with hypothyroidism in 2.82% and "low-T3 syndrome" in 22.9%. Multivariate regression analysis showed that eGFR was a strong independent predictor of serum fT3 levels in patients with eGFR < 60 ml/min. Impaired kidney function was associated with low fT4 and fT3 but not TSH. Our findings showed an inverse correlation of fT3 and fT4 levels and proteinuria range. FT4 inversely correlated with the extent of proteinuria in all subgroups of patients. In contrast, the inverse correlation of fT3 serum levels and proteinuria disappeared in patients with eGFR < 60 ml/min. CONCLUSION In a large cohort of inpatients, the prevalence of low-T3 syndrome was 2.5 times higher in patients with advanced kidney disease, compared to those with normal kidney function. In advanced CKD, both eGFR and proteinuria were strongly correlated with thyroid hormones. Therefore, close screening of the "thyroid profile" in patients with any stage of CKD, especially to those with proteinuria, might be warranted.
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Affiliation(s)
- Juliane Peters
- Clinic of Nephrology and Hypertension, Diabetes and Endocrinology, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany
| | - Stefanos Roumeliotis
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, School of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, St. Kyriakidi 1, 54636, Thessaloniki, Greece
| | - Peter R Mertens
- Clinic of Nephrology and Hypertension, Diabetes and Endocrinology, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany
| | - Vassilios Liakopoulos
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, School of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, St. Kyriakidi 1, 54636, Thessaloniki, Greece.
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Schultheiss UT, Steinbrenner I, Nauck M, Schneider MP, Kotsis F, Baid-Agrawal S, Schaeffner E, Eckardt KU, Köttgen A, Sekula P. Thyroid function, renal events and mortality in chronic kidney disease patients: the German Chronic Kidney Disease study. Clin Kidney J 2021; 14:959-968. [PMID: 34349984 PMCID: PMC8328092 DOI: 10.1093/ckj/sfaa052] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 03/18/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hypothyroidism and low free triiodothyronine (FT3) syndrome [low FT3 levels with normal thyroid-stimulating hormone (TSH)] have been associated with reduced kidney function cross-sectionally in chronic kidney disease (CKD) patients with severely reduced estimated glomerular filtration rate (eGFR) or end-stage kidney disease (ESKD). Results on the prospective effects of impaired thyroid function on renal events and mortality for patients with severely reduced eGFR or from population-based cohorts are conflicting. Here we evaluated the association between thyroid and kidney function with eGFR (cross-sectionally) as well as renal events and mortality (prospectively) in a large, prospective cohort of CKD patients with mild to moderately reduced kidney function. METHODS Thyroid markers were measured among CKD patients from the German Chronic Kidney Disease study. Incident renal endpoints (combined ESKD, acute kidney injury and renal death) and all-cause mortality were abstracted from hospital records and death certificates. Time to first event analysis of complete data from baseline to the 4-year follow-up (median follow-up time 4.04 years) of 4600 patients was conducted. Multivariable linear regression and Cox proportional hazards models were fitted for single and combined continuous thyroid markers [TSH, free thyroxine (FT4), FT3] and thyroid status. RESULTS Cross-sectionally, the presence of low-FT3 syndrome showed a significant inverse association with eGFR and continuous FT3 levels alone showed a significant positive association with eGFR; in combination with FT4 and TSH, FT3 levels also showed a positive association and FT4 levels showed a negative association with eGFR. Prospectively, higher FT4 and lower FT3 levels were significantly associated with a higher risk of all-cause mortality (N events = 297). Per picomole per litre higher FT3 levels the risk of reaching the composite renal endpoint was 0.73-fold lower (95% confidence interval 0.65-0.82; N events = 615). Compared with euthyroid patients, patients with low-FT3 syndrome had a 2.2-fold higher risk and patients with hypothyroidism had a 1.6-fold higher risk of experiencing the composite renal endpoint. CONCLUSIONS Patients with mild to moderate CKD suffering from thyroid function abnormalities are at an increased risk of adverse renal events and all-cause mortality over time.
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Affiliation(s)
- Ulla T Schultheiss
- Institute of Genetic Epidemiology, Medical Center – University of Freiburg, Faculty of Medicine, Freiburg, Germany
- Department of Medicine IV – Nephrology and Primary Care, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Inga Steinbrenner
- Institute of Genetic Epidemiology, Medical Center – University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Markus P Schneider
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Fruzsina Kotsis
- Institute of Genetic Epidemiology, Medical Center – University of Freiburg, Faculty of Medicine, Freiburg, Germany
- Department of Medicine IV – Nephrology and Primary Care, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Seema Baid-Agrawal
- Department of Nephrology and Transplant Center, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Elke Schaeffner
- Institute of Public Health, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Kai-Uwe Eckardt
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Department of Nephrology and Medical Intensive Care, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Anna Köttgen
- Institute of Genetic Epidemiology, Medical Center – University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Peggy Sekula
- Institute of Genetic Epidemiology, Medical Center – University of Freiburg, Faculty of Medicine, Freiburg, Germany
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Abstract
Hypothyroidism is a highly prevalent endocrine complication in chronic kidney disease (CKD) patients. A large body of evidence has shown that there is a bidirectional relationship between thyroid dysfunction and kidney disease, yet there are many remaining gaps in knowledge in regards to the clinical management of CKD patients with hypothyroidism, including those receiving hemodialysis and peritoneal dialysis. Given that hypothyroidism has been associated with many deleterious outcomes including a higher risk of (1) mortality, (2) cardiovascular disease, (3) impaired health-related quality of life, and (4) altered body composition in both non-CKD and CKD patients, future research is needed to establish the appropriate screening, diagnosis, and treatment approaches in these populations.
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Affiliation(s)
- Yoko Narasaki
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine, Orange, CA
| | - Peter Sohn
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine, Orange, CA
| | - Connie M Rhee
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine, Orange, CA.
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25
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Effect of Levothyroxine on Kidney Function in Chronic Kidney Disease with Subclinical Hypothyroidism in US Veterans: A Retrospective Observational Cohort Study. Adv Ther 2021; 38:1185-1201. [PMID: 33355908 PMCID: PMC7889570 DOI: 10.1007/s12325-020-01589-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/28/2020] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Chronic kidney disease (CKD) may be associated with overt or subclinical hypothyroidism [SCH; defined as elevated serum thyroid-stimulating hormone (TSH) despite normal free thyroxine levels). Although some studies have demonstrated that thyroid replacement therapy may improve renal function in overt hypothyroidism, there is no consensus on its benefits in SCH. Clinical and limited economic outcomes were evaluated in levothyroxine-treated US veterans with CKD + SCH. METHODS Veterans Health Administration claims data from April 2013 to March 2018 for levothyroxine-treated versus nontreated CKD + SCH patients were compared. Eligible patients with CKD + SCH (≥ 2 elevated TSH values recorded; ≥ 2 normal thyroxine values recorded) had ≥ 1 TSH values recorded during 24-month follow-up, and ≥ 1 estimated glomerular filtration rate (eGFR) measurement during baseline and follow-up. Continuous levothyroxine use (treatment cohort) was required during follow-up. The primary endpoint was eGFR at 6, 12, 18, and 24 months; secondary endpoints included eGFR change from baseline, CKD progression, and length of hospital stay (LOS). Propensity score matching (PSM) was performed. RESULTS Of 453 eligible patients, 157 remained in each cohort after PSM. Most were male (96%) and white (88%); mean age was 75 years. No significant differences were observed between cohorts at any time point for eGFR, eGFR change from baseline, or CKD progression. Treated patients had numerically higher mean eGFR at 6 and 12 months, lower proportions of progression to higher CKD stages at 12, 18, and 24 months, and shorter mean all-cause LOS versus nontreated patients (1.92 vs. 3.30 days; P = 0.3483) within the 24-month follow-up period. A significantly shorter mean CKD-related LOS was observed versus nontreated patients (0.11 vs. 1.38 days; P < 0.0001) during the 24-month follow-up. CONCLUSION Levothyroxine use was associated with economic and clinical benefit in some patients with CKD + SCH, despite an absence of overall benefit on eGFR; confirmatory research is needed.
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Masood A, Benabdelkamel H, Jammah AA, Ekhzaimy AA, Alfadda AA. Identification of Protein Changes in the Urine of Hypothyroid Patients Treated with Thyroxine Using Proteomics Approach. ACS OMEGA 2021; 6:2367-2378. [PMID: 33521475 PMCID: PMC7841925 DOI: 10.1021/acsomega.0c05686] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/04/2021] [Indexed: 05/14/2023]
Abstract
The thyroid gland and thyroid hormones control a multitude of homeostatic functions including maintenance of fluid and electrolyte balance and normal functioning of the kidneys. Thyroid dysfunction alters the sytemic hemodynamic and metabolic balance, thereby affecting the kidney. In this study, we aimed to identify and characterize the urinary proteome of the patients with hypothyroidism. An untargeted proteomic approach with network analysis was used to identify changes in total urinary proteome in patients with newly diagnosed overt hypothyroidism. Urine samples were collected from nine age-matched patients' before and after l-thyroxine treatment. Differences in the abundance of urinary proteins between hypothyroid and euthyroid states were determined using a two-dimensional difference in gel electrophoresis (2D-DIGE) coupled to matrix-assisted laser desorption and ionization time-of-flight (MALDI TOF) mass spectrometry. Alterations in the abundance of urinary proteins, analyzed by Progenesis software, revealed statistically significant differential abundance in a total of 49 spots corresponding to 42 proteins, 28 up and 14 down (≥1.5-fold change, analysis of variance (ANOVA), p ≤ 0.05). The proteins identified in the study are known to regulate processes related to transport, acute phase response, oxidative stress, generation of reactive oxygen species, cellular proliferation, and endocytosis. Bioinformatic analysis using Ingenuity Pathway Analysis (IPA) identified dysregulation of pathways related to amino acid metabolism, molecular transport, and small-molecule biochemistry and involved the MAPK kinase, vascular endothelial growth factor (VEGF), PI3 kinase/Akt, protein kinase C (PKC), signaling pathways. The identified proteins were involved in the regulation of thyroglobulin (Tg) and thyrotropin (TSH) metabolism. Alterations in their levels indicate the presence of a compensatory mechanism aimed at increasing the regulation of Tg in the hypothyroid state.
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Affiliation(s)
- Afshan Masood
- Proteomics
Resource Unit, Obesity Research Center, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia
| | - Hicham Benabdelkamel
- Proteomics
Resource Unit, Obesity Research Center, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia
| | - Anwar A. Jammah
- Department
of Medicine, College of Medicine and King Saud Medical City, King Saud University, Riyadh 12372, Saudi Arabia
| | - Aishah A. Ekhzaimy
- Department
of Medicine, College of Medicine and King Saud Medical City, King Saud University, Riyadh 12372, Saudi Arabia
| | - Assim A. Alfadda
- Proteomics
Resource Unit, Obesity Research Center, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia
- Department
of Medicine, College of Medicine and King Saud Medical City, King Saud University, Riyadh 12372, Saudi Arabia
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Jankauskas SS, Morelli MB, Gambardella J, Lombardi A, Santulli G. Thyroid hormones regulate both cardiovascular and renal mechanisms underlying hypertension. J Clin Hypertens (Greenwich) 2020; 23:373-381. [PMID: 33377271 PMCID: PMC8030083 DOI: 10.1111/jch.14152] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 11/27/2020] [Accepted: 12/13/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Stanislovas S Jankauskas
- Department of Medicine, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, USA
| | - Marco B Morelli
- Department of Medicine, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, USA.,Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, NY, USA
| | - Jessica Gambardella
- Department of Medicine, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, USA.,Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, NY, USA.,Department of Advanced Biomedical Science, "Federico II" University, and International Translational Research and Medical Education Consortium (ITME), Naples, Italy
| | - Angela Lombardi
- Department of Medicine, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, USA.,Department of Microbiology and Immunology, Albert Einstein College of Medicine, New York, NY, USA
| | - Gaetano Santulli
- Department of Medicine, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY, USA.,Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, NY, USA.,Department of Advanced Biomedical Science, "Federico II" University, and International Translational Research and Medical Education Consortium (ITME), Naples, Italy
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Zoja C, Xinaris C, Macconi D. Diabetic Nephropathy: Novel Molecular Mechanisms and Therapeutic Targets. Front Pharmacol 2020; 11:586892. [PMID: 33519447 PMCID: PMC7845653 DOI: 10.3389/fphar.2020.586892] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 11/20/2020] [Indexed: 12/13/2022] Open
Abstract
Diabetic nephropathy (DN) is one of the major microvascular complications of diabetes mellitus and the leading cause of end-stage kidney disease. The standard treatments for diabetic patients are glucose and blood pressure control, lipid lowering, and renin-angiotensin system blockade; however, these therapeutic approaches can provide only partial renoprotection if started late in the course of the disease. One major limitation in developing efficient therapies for DN is the complex pathobiology of the diabetic kidney, which undergoes a set of profound structural, metabolic and functional changes. Despite these difficulties, experimental models of diabetes have revealed promising therapeutic targets by identifying pathways that modulate key functions of podocytes and glomerular endothelial cells. In this review we will describe recent advances in the field, analyze key molecular pathways that contribute to the pathogenesis of the disease, and discuss how they could be modulated to prevent or reverse DN.
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Affiliation(s)
- Carlamaria Zoja
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy
| | - Christodoulos Xinaris
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy.,University of Nicosia Medical School, Nicosia, Cyprus
| | - Daniela Macconi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy
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Torkian P, Mansournia MA, Mansournia N. Evaluation of biochemical markers of kidney function in patients with subclinical hypothyroidism in comparison with euthyroid people. J Family Med Prim Care 2020; 9:4234-4239. [PMID: 33110838 PMCID: PMC7586516 DOI: 10.4103/jfmpc.jfmpc_757_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/21/2020] [Accepted: 07/05/2020] [Indexed: 12/02/2022] Open
Abstract
Background: Subclinical hypothyroidism (SCH) as a compensated or preclinical type of primary and overt hypothyroidism (OHT) can affect approximately 4–10% of the general population. Treating SCH can slowdown the progression to OHT, the formation of cardiovascular diseases, neuropsychiatric symptoms, and other miscellaneous problems. Materials and Methods: The present study is a case-control study that was conducted on 239 adults who were referred to 501 Imam Reza Hospital from March 2019 up to September 2019. Of the 239 patients and their families admitted to the hospital, 121 (50.6%) were euthyroid (as control group) and the remaining participants (118, 49.4%) were SCH (as case group). The serum levels of thyroid stimulating hormone (TSH), urea, uric acid, creatinine, T3, and T4 were asked to be determined at a single laboratory. Biochemical markers of kidney function and the level of thyroid hormones were compared between the two groups of euthyroid and SCH. Results: TSH was significantly higher in SCH (7.25 (4.4-18.15)) compared to euthyroid (1.4 (0.2-3.7)) patients (P < 0.001). Among biochemical markers, creatinine (P < 0.001) and uric acid (P = 0.006) had higher serum levels in the case group. There was no remarkable difference in the thyroxine hormone levels and urea between the euthyroid and SCH patients (P > 0.05). Within the SCH group, there was a significant positive correlation between TSH and the level of creatinine (P = 0.001, r = 0.302). Conclusion: Regular monitoring of the major function of the kidneys in patients with hypothyroidism and SCH can help early diagnosis of kidney dysfunction, thus increasing the chance of restoring normal kidney function.
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Affiliation(s)
- Pooya Torkian
- Metabolic Disease Research Center, Faculty of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Nasrin Mansournia
- Metabolic Disease Research Center, Faculty of Medicine, AJA University of Medical Sciences, Tehran, Iran
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Kim SH, Min HK, Lee SW. Relationship between Thyroid and Kidney Function: Analysis from the Korea National Health and Nutrition Examination Survey Between 2013 and 2015. Kidney Blood Press Res 2020; 45:442-454. [PMID: 32369813 DOI: 10.1159/000507290] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 03/16/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Thyroid function is evaluated by thyroid stimulating hormone (TSH) and free thyroxine (fT4). Although many studies have indicated an intimate relationship between thyroid hormones and kidney functions, reports about the simultaneous evaluation of TSH and fT4 are rare. OBJECTIVE We aimed to analyze the association between TSH and kidney function, with emphasis on a potential nonlinear relationship, and identify an independent relationship between fT4 and kidney function. METHODS We reviewed the data of 7,061 subjects in the Korea National Health and Nutrition Examination Surveys who were randomly subsampled for thyroid function evaluation between 2013 and 2015. A total of 5,578 subjects were included in the final analysis, after excluding people <18 years old, and those with a short fasting time, abnormal fT4 levels, and thyroid disease or related medications. Creatinine-based estimated glomerular filtration rate (eGFR) was used to define kidney function. RESULTS A 1 mmol/L increase of logarithmic TSH was associated with decreased eGFR (β: -1.8; 95% CI -2.3 to -1.2; p < 0.001), according to multivariate linear regression analysis. On the multivariate generalized additive model plot, TSH demonstrated an L-shaped relationship with eGFR, showing a steeper slope for 0-4 mIU/L of TSH. A 1 µg/dL increase of fT4 was also associated with decreased eGFR (β: -7.0; 95% CI -0.94 to -4.7; p < 0.001) on the multivariate linear regression analysis; this association was reversed after adjusting for age. On the mediation analysis, the indirect effect via age and direct effect per 1 µg/dL increase of fT4 on eGFR was 9.9 (8.1 to 11.7, p < 0.001) and -7.1 (-9.3 to -4.8, p < 0.001), respectively. CONCLUSIONS Increased TSH was associated with decreased eGFR, particularly in the reference range. The direct effect of increased fT4 was decreased eGFR, which may be affected indirectly by age.
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Affiliation(s)
- Sang Hyuk Kim
- Medical Service Corps of 2nd Armored Brigade, Republic of Korea Army, Paju, Republic of Korea
| | - Hyang Ki Min
- Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea
| | - Sung Woo Lee
- Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea,
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Silvestrini A, Mordente A, Martino G, Bruno C, Vergani E, Meucci E, Mancini A. The Role of Selenium in Oxidative Stress and in Nonthyroidal Illness Syndrome (NTIS): An Overview. Curr Med Chem 2020; 27:423-449. [PMID: 29421998 DOI: 10.2174/0929867325666180201111159] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 01/12/2018] [Accepted: 01/13/2018] [Indexed: 12/28/2022]
Abstract
Selenium is a trace element, nutritionally classified as an essential micronutrient, involved in maintaining the correct function of several enzymes incorporating the selenocysteine residue, namely the selenoproteins. The human selenoproteome including 25 proteins is extensively described here. The most relevant selenoproteins, including glutathione peroxidases, thioredoxin reductases and iodothyronine deiodinases are required for the proper cellular redox homeostasis as well as for the correct thyroid function, thus preventing oxidative stress and related diseases. This review summarizes the main advances on oxidative stress with a focus on selenium metabolism and transport. Moreover, thyroid-related disorders are discussed, considering that the thyroid gland contains the highest selenium amount per gram of tissue, also for future possible therapeutic implication.
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Affiliation(s)
- Andrea Silvestrini
- Institute of Biochemistry and Clinical Biochemistry, School of Medicine, Catholic University, Largo F. Vito 1, Rome 00168, Italy
| | - Alvaro Mordente
- Institute of Biochemistry and Clinical Biochemistry, School of Medicine, Catholic University, Largo F. Vito 1, Rome 00168, Italy
| | - Giuseppe Martino
- Operative Unit of Endocrinology, School of Medicine, Catholic University, Largo A. Gemelli 1, Rome, 00168, Italy
| | - Carmine Bruno
- Operative Unit of Endocrinology, School of Medicine, Catholic University, Largo A. Gemelli 1, Rome, 00168, Italy
| | - Edoardo Vergani
- Operative Unit of Endocrinology, School of Medicine, Catholic University, Largo A. Gemelli 1, Rome, 00168, Italy
| | - Elisabetta Meucci
- Institute of Biochemistry and Clinical Biochemistry, School of Medicine, Catholic University, Largo F. Vito 1, Rome 00168, Italy
| | - Antonio Mancini
- Operative Unit of Endocrinology, School of Medicine, Catholic University, Largo A. Gemelli 1, Rome, 00168, Italy
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Effect of Thyroid Hormones on Kidney Function in Patients after Kidney Transplantation. Sci Rep 2020; 10:2156. [PMID: 32034263 PMCID: PMC7005730 DOI: 10.1038/s41598-020-59178-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 01/15/2020] [Indexed: 11/21/2022] Open
Abstract
Elevated levels of thyroid-stimulating-hormone (TSH) are associated with reduced glomerular filtration rate (GFR) and increased risk of developing chronic kidney disease even in euthyroid patients. Thyroid hormone replacement therapy has been shown to delay progression to end-stage renal disease in sub-clinically hypothyroid patients with renal insufficiency. However, such associations after kidney transplantation were never investigated. In this study the association of thyroid hormones and estimated GFR (eGFR) in euthyroid patients after kidney transplantation was analyzed. In total 398 kidney transplant recipients were assessed retrospectively and association between thyroid and kidney function parameters at and between defined time points, 12 and 24 months after transplantation, was studied. A significant inverse association was shown for TSH changes and eGFR over time between months 12 and 24 post transplantation. For each increase of TSH by 1 µIU/mL, eGFR decreased by 1.34 mL/min [95% CI, −2.51 to −0.16; p = 0.03], corresponding to 2.2% eGFR decline, within 12 months. At selected time points 12 and 24 months post transplantation, however, TSH was not associated with eGFR. In conclusion, an increase in TSH between 12 and 24 months after kidney transplantation leads to a significant decrease in eGFR, which strengthens the concept of a kidney-thyroid-axis.
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de Souza ABC, Arantes MF, Zatz R, Elias RM, Lopes RI, Macedo E. Influence of low free thyroxine on progression of chronic kidney disease. BMC Nephrol 2020; 21:36. [PMID: 32000713 PMCID: PMC6993384 DOI: 10.1186/s12882-019-1677-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 12/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hypothyroidism is highly prevalent in patients with chronic kidney disease (CKD) and has been associated with poorer clinical outcomes, including faster decline of kidney function. However, there is no consensus whether low free thyroxin (LFT) affects the rate of estimated glomerular filtration rate (eGFR) decline and how the presence of proteinuria influences the progression of renal dysfunction in hypothyroidism. METHODS We assessed thyroid status, proteinuria, and progression of eGFR by Modification of Diet in Renal Disease equation and CKD-EPI equation in a cohort of CKD patients followed in general nephrology clinics. We estimated the association of LFT levels, and the degree of proteinuria on progression of eGFR. We adjusted for other covariables: age, gender, body mass index, diabetes, hypertension, HbA1c, uric acid, cholesterol, and triglycerides levels.. RESULTS One thousand six hundred ten patients (64 ± 15 years, 46.8% men, 25.3% diabetic) were included. At beggnining of follow up eGFR was between 45 and 60, 30-45 and 15-30 ml/min/1.73m2 in 479 (29.8%), 551(34.2%), and 580(36.0%) patients, respectively. LFT levels were available at initial evaluation in 288(17.9%) patients and 735(48.5%) had assessment of proteinuria (19.6% with LFT vs. 15.4% without LFT, p = 0.032). Median follow-up time was of 21 months, and 1223(76%) had at least 1 year of follow up. Overall, eGFR decline per month was - 0.05(- 0.26, 0.23) ml/min/1.73m2, reaching 1.7(1.3, 2.4) ml/min/1.73m2 by the end of study period. Similar results were obtained using CKD-EPI. Multivariable mixed linear analysis showed that proteinuria and age were independently associated with eGFR decline, with no effect of LFT, and no interaction between proteinuria and LFT. In patients without proteinuria, there was an improvement of eGFR despite the presence of LFT. CONCLUSIONS We confirmed a faster rate of eGFR declined in patients with proteinuria. However, despite the pathophysiological rational that hypothyroidism can lead to increased rate of CKD progression, we failed to demonstrate an association between LFT and rate of CKD progression. We conclude that the benefit of hypothyroidism treatment in CKD patients needs to be evaluate in prospective studies.
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Affiliation(s)
| | - Marcia Fernanda Arantes
- Nephrology Service, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil.
| | - Roberto Zatz
- Nephrology Service, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Rosilene Motta Elias
- Nephrology Service, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
- Universidade Nove de Julho, UNINOVE, São Paulo, Brazil
| | - Roberto Iglesias Lopes
- Urology Service Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Etienne Macedo
- Nephrology Division, Department of Medicine, University of California San Diego, San Diego, California, USA
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Meuwese CL, van Diepen M, Cappola AR, Sarnak MJ, Shlipak MG, Bauer DC, Fried LP, Iacoviello M, Vaes B, Degryse J, Khaw KT, Luben RN, Åsvold BO, Bjøro T, Vatten LJ, de Craen AJM, Trompet S, Iervasi G, Molinaro S, Ceresini G, Ferrucci L, Dullaart RPF, Bakker SJL, Jukema JW, Kearney PM, Stott DJ, Peeters RP, Franco OH, Völzke H, Walsh JP, Bremner A, Sgarbi JA, Maciel RMB, Imaizumi M, Ohishi W, Dekker FW, Rodondi N, Gussekloo J, den Elzen WPJ. Low thyroid function is not associated with an accelerated deterioration in renal function. Nephrol Dial Transplant 2020; 34:650-659. [PMID: 29684213 DOI: 10.1093/ndt/gfy071] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is frequently accompanied by thyroid hormone dysfunction. It is currently unclear whether these alterations are the cause or consequence of CKD. This study aimed at studying the effect of thyroid hormone alterations on renal function in cross-sectional and longitudinal analyses in individuals from all adult age groups. METHODS Individual participant data (IPD) from 16 independent cohorts having measured thyroid stimulating hormone, free thyroxine levels and creatinine levels were included. Thyroid hormone status was defined using clinical cut-off values. Estimated glomerular filtration rates (eGFR) were calculated by means of the four-variable Modification of Diet in Renal Disease (MDRD) formula. For this IPD meta-analysis, eGFR at baseline and eGFR change during follow-up were computed by fitting linear regression models and linear mixed models in each cohort separately. Effect estimates were pooled using random effects models. RESULTS A total of 72 856 individuals from 16 different cohorts were included. At baseline, individuals with overt hypothyroidism (n = 704) and subclinical hypothyroidism (n = 3356) had a average (95% confidence interval) -4.07 (-6.37 to -1.78) and -2.40 (-3.78 to -1.02) mL/min/1.73 m2 lower eGFR as compared with euthyroid subjects (n = 66 542). In (subclinical) hyperthyroid subjects (n = 2254), average eGFR was 3.01 (1.50-4.52) mL/min/1.73 m2 higher. During 329 713 patient years of follow-up, eGFR did not decline more rapidly in individuals with low thyroid function compared with individuals with normal thyroid function. CONCLUSIONS Low thyroid function is not associated with a deterioration of renal function. The cross-sectional association may be explained by renal dysfunction causing thyroid hormone alterations.
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Affiliation(s)
- Christiaan L Meuwese
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Merel van Diepen
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Anne R Cappola
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Mark J Sarnak
- Department of Medicine, Division of Nephrology, Tufts Medical Center, Boston, MA, USA
| | - Michael G Shlipak
- Department of Medicine, UCSF School of Medicine, San Francisco, CA, USA
| | - Douglas C Bauer
- Department of Medicine, University of California, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of San Francisco, CA, USA
| | - Linda P Fried
- Mailman School of Public Health and Columbia University Medical Center, New York, NY, USA
| | - Massimo Iacoviello
- University Cardiology Unit, Cardiothoracic Department, University Policlinic Hospital, Bari, Italy
| | - Bert Vaes
- Institute of Health and Society, Université catholique de Louvain (UCL), Brussels, Belgium.,Department of Public Health and Primary Care, Katholieke Universiteit Leuven (KUL), Leuven, Belgium
| | - Jean Degryse
- Institute of Health and Society, Université catholique de Louvain (UCL), Brussels, Belgium.,Department of Public Health and Primary Care, Katholieke Universiteit Leuven (KUL), Leuven, Belgium
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Robert N Luben
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Bjørn O Åsvold
- Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Endocrinology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Trine Bjøro
- Department of Medical Biochemistry, Oslo University Hospital, and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lars J Vatten
- Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anton J M de Craen
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Stella Trompet
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands.,Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Giorgio Iervasi
- National Council Research Institute of Clinical Physiology, Tuscany Region G. Monasterio Foundation, Pisa, Italy
| | - Sabrina Molinaro
- National Council Research Institute of Clinical Physiology, Pisa, Italy
| | - Graziano Ceresini
- Department of Clinical and Experimental Medicine, Geriatric Endocrine Unit, University Hospital of Parma, Parma, Italy
| | | | - Robin P F Dullaart
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stephan J L Bakker
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - David J Stott
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Robin P Peeters
- Department of Internal Medicine, Rotterdam Thyroid Center, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Oscar H Franco
- Department of Internal Medicine, Rotterdam Thyroid Center, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Henry Völzke
- Institute for Community Medicine, SHIP/Clinical-Epidemiological Research & German Centre of Cardiovascular Research, University of Greifswald, Greifswald, Germany
| | - John P Walsh
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia.,Medical School, The University of Western Australia, Crawley, Western Australia
| | - Alexandra Bremner
- School of Population Health, The University of Western Australia, Crawley, Western Australia
| | - José A Sgarbi
- Division of Endocrinology, Faculdade de Medicina de Marília, Marília, Brazil
| | - Rui M B Maciel
- Division of Endocrinology, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Misa Imaizumi
- Department of Clinical Studies, Radiation Effects Research Foundation, Hiroshima and Nagasaki, Japan
| | - Waka Ohishi
- Department of Clinical Studies, Radiation Effects Research Foundation, Hiroshima and Nagasaki, Japan
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, University of Bern, Bern, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Jacobijn Gussekloo
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Wendy P J den Elzen
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, The Netherlands
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Deng X, Tang C, Wu J, Han R, Fang F. Changes of nutritional status and the variations of serum indicators of patients with chronic kidney disease accompanied by hypothyroidism taking thyroid hormone replacement therapy as the therapeutic models. Saudi J Biol Sci 2020; 26:2091-2095. [PMID: 31889800 PMCID: PMC6923455 DOI: 10.1016/j.sjbs.2019.09.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 09/21/2019] [Accepted: 09/24/2019] [Indexed: 12/01/2022] Open
Abstract
This study aimed to analyze the incidence of malnutrition in patients with chronic kidney disease (CKD) at stage III-IV accompanied by hypothyroidism and indicate the improvement in nutritional status and kidney disease of CKD patients after undergoing thyroid hormone replacement (THR) therapy as therapeutic models. The included 156 CKD patients in stage III-IV were divided into the CKD stage III group (CKD-III group) (n = 80) and CKD stage IV group (CKD-IV group) (n = 76), and the clinical indicators of all the patients were collected. Based on changes in thyroid function, the included patients were again divided into the following groups: subclinical hypothyroidism group (the experimental group, hereinafter referred to Y-group, n = 78) and non-subclinical hypothyroidism group (the control group, hereinafter referred to N-group, n = 78), in which the CKD-III group was divided into CKD-IIIN group (n = 38) and CKD-IIIY group (n = 42), and also the CKD-IV group was divided into CKD-IVN group (n = 40) and CKD-IVY group (n = 36). At the beginning, patients in the Y-group was orally given 25 μg/dL of levothyroxine; based on the progression of the disease, the dosage was regulated; the concentration of serum thyroid stimulating hormone (TSH) was assessed once per month, as well as changes in tri-iodothyronine (T3) and tetraiodothyronine (T4). Estimated glomerular filtration rate (eGFR) in the CKD-IIIY group was significantly changed compared with that of the CKD-IVY group after THR therapy. Comparison of nutrition-based indicators between the N-group and the Y-group showed that the serum albumin (ALB) level, the hemoglobin (HGB) level, and the grip strength of both the left and right hand were notably decreased (P < 0.05). After THR therapy, the indicators related to CKD patients were accompanied by subclinical hypothyroidism changes; the levels of ALB and HGB, as well as the grip strength of both the left and right hand were notably increased compared with before undergoing THR therapy (P < 0.05). In conclusion, malnutrition of chronic kidney disease caused by subclinical hypothyroidism could be partially recovered after THR therapy as therapeutic models.
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Affiliation(s)
- Xin Deng
- Department of Clinical Nutrition, Chongqing Traditional Chinese Medicine Hospital, Chongqing City 400021, China
| | - Cai Tang
- Department of Endocrinology, Chongqing Traditional Chinese Medicine Hospital, Chongqing City 400021, China
| | - Jinlin Wu
- Department of Endocrinology, Chongqing Traditional Chinese Medicine Hospital, Chongqing City 400021, China
| | - Rui Han
- Department of Endocrinology, Chongqing Traditional Chinese Medicine Hospital, Chongqing City 400021, China
| | - Fang Fang
- Department of Endocrinology, Chongqing Traditional Chinese Medicine Hospital, Chongqing City 400021, China
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36
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Abstract
PURPOSE OF REVIEW Hypothyroidism is a highly prevalent endocrine disorder in the end-stage renal disease (ESRD) population, yet many cases may remain latent and undiagnosed. RECENT FINDINGS Epidemiologic data show that there is a nearly five-fold higher prevalence of hypothyroidism in advanced chronic kidney disease (CKD) patients vs. those without CKD. Given that the metabolism, degradation, and excretion of thyroid hormone and its metabolites, as well as the regulation of the hypothalamic-pituitary-thyroid axis may be altered in ESRD, certain considerations should be made when interpreting thyroid functional tests in these patients. Growing evidence shows that hypothyroidism and other thyroid functional test derangements are associated with higher risk of cardiovascular disease, worse patient-centered outcomes, and survival in the advanced CKD population, including those with ESRD. Although limited data examining treatment of hypothyroidism suggests benefit, further studies of the efficacy and safety of thyroid hormone supplementation, including clinical trials and rigorous longitudinal observational studies are needed to inform the management of thyroid dysfunction in CKD. SUMMARY Given the high burden of hypothyroidism in ESRD patients, and potential ill effects on their cardiovascular health, patient-centered outcomes, and survival, further research is needed to inform the optimal management of thyroid dysfunction in this population.
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Affiliation(s)
- Connie M. Rhee
- Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA
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37
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Mourouzis I, Lavecchia AM, Xinaris C. Thyroid Hormone Signalling: From the Dawn of Life to the Bedside. J Mol Evol 2019; 88:88-103. [PMID: 31451837 DOI: 10.1007/s00239-019-09908-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/13/2019] [Indexed: 12/19/2022]
Abstract
Thyroid hormone (TH) signalling is a key modulator of fundamental biological processes that has been evolutionarily conserved in both vertebrate and invertebrate species. TH may have initially emerged as a nutrient signal to convey environmental information to organisms to induce morpho-anatomical changes that could maximise the exploitation of environmental resources, and eventually integrated into the machinery of gene regulation and energy production to become a key regulator of development and metabolism. As such, TH signalling is particularly sensitive to environmental stimuli, and its alterations result in fundamental changes in homeostasis and physiology. Stressful stimuli of various origins lead to changes in the TH-TH receptor (TR) axis in different adult mammalian organs that are associated with phenotypical changes in terminally differentiated cells, the reactivation of foetal development programmes, structural remodelling and pathological growth. Here, we discuss the evolution of TH signalling, review evolutionarily conserved functions of THs in essential biological processes, such as metamorphosis and perinatal development, and analyse the role of TH signalling in the phenotypical and morphological changes that occur after injury, repair and regeneration in adult mammalian organs. Finally, we examine the potential of TH treatment as a therapeutic strategy for improving organ structure and functions following injury.
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Affiliation(s)
- Iordanis Mourouzis
- Department of Pharmacology, University of Athens, 75 Mikras Asias Ave., Goudi, 11527, Athens, Greece
| | - Angelo Michele Lavecchia
- Laboratory of Organ Regeneration, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Stezzano 87, 24126, Bergamo, Italy
| | - Christodoulos Xinaris
- Laboratory of Organ Regeneration, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Stezzano 87, 24126, Bergamo, Italy. .,University of Nicosia Medical School, 93 Agiou Nikolaou Street, Engomi, 2408, Nicosia, Cyprus.
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38
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Han Q, Zhang J, Wang Y, Li H, Zhang R, Guo R, Li L, Teng G, Wang J, Wang T, Liu F. Thyroid hormones and diabetic nephropathy: An essential relationship to recognize. Nephrology (Carlton) 2019; 24:160-169. [PMID: 29660205 DOI: 10.1111/nep.13388] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2018] [Indexed: 02/05/2023]
Affiliation(s)
- Qianqian Han
- Division of Nephrology; West China Hospital of Sichuan University; Chengdu China
| | - Junlin Zhang
- Division of Nephrology; West China Hospital of Sichuan University; Chengdu China
| | - Yiting Wang
- Division of Nephrology; West China Hospital of Sichuan University; Chengdu China
| | - Hanyu Li
- Division of Nephrology; West China Hospital of Sichuan University; Chengdu China
| | - Rui Zhang
- Division of Nephrology; West China Hospital of Sichuan University; Chengdu China
| | - Ruikun Guo
- Division of Nephrology; West China Hospital of Sichuan University; Chengdu China
| | - Li Li
- Division of Nephrology; West China Hospital of Sichuan University; Chengdu China
| | - Geer Teng
- The Faculty of Social Development and Western China Development Studies; Sichuan University; Chengdu China
| | - Jiali Wang
- Division of Nephrology; West China Hospital of Sichuan University; Chengdu China
| | - Tingli Wang
- Division of Nephrology; West China Hospital of Sichuan University; Chengdu China
| | - Fang Liu
- Division of Nephrology; West China Hospital of Sichuan University; Chengdu China
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39
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Breitzig MT, Alleyn MD, Lockey RF, Kolliputi N. Thyroid hormone: a resurgent treatment for an emergent concern. Am J Physiol Lung Cell Mol Physiol 2018; 315:L945-L950. [PMID: 30260285 PMCID: PMC6337010 DOI: 10.1152/ajplung.00336.2018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/20/2018] [Accepted: 09/23/2018] [Indexed: 12/16/2022] Open
Abstract
The story of thyroid hormone in human physiology is one of mixed emotions. Studying past literature on its use leads one to believe that it serves only a few functions in a handful of diseases. In reality, the pathophysiological role of thyroid hormone is an uncharted expanse. Over the past few decades, research on thyroid hormone has been understandably monopolized by studies of hypo- and hyperthyroidism and cancers. However, in our focused pursuit, we have neglected to observe its role in systems that are not so easily relatable. Recent evidence in lung disease suggests that the thyroid hormone is capable of preserving mitochondria in an indirect manner. This is an exciting revelation given the profound implications of mitochondrial dysfunction in several lung diseases. When paired with known links between thyroid hormone and fibrotic pathways, thyroid hormone-based therapies become more enticing for research. In this article, we inspect the sudden awareness surrounding thyroid hormone and discuss why it is of paramount importance that further studies scrutinize the potential of thyroid hormone, and/or thyromimetics, as therapies for lung diseases.
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Affiliation(s)
- Mason T Breitzig
- Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida , Tampa, Florida
| | - Matthew D Alleyn
- Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida , Tampa, Florida
| | - Richard F Lockey
- Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida , Tampa, Florida
| | - Narasaiah Kolliputi
- Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida , Tampa, Florida
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40
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Rosario PWS, Calsolari MR. Impact of subclinical hypothyroidism with TSH ≤10 mIU/L on glomerular filtration rate in adult women without known kidney disease. Endocrine 2018; 59:694-697. [PMID: 29327299 DOI: 10.1007/s12020-017-1496-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 12/05/2017] [Indexed: 10/18/2022]
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41
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Sayari S, Molaei Z, Torabi Z. The relationship between subclinical hypothyroidism and serum levels of uric acid and creatinine in children aged 2-14 years. Ann Pediatr Endocrinol Metab 2018; 23:38-42. [PMID: 29609448 PMCID: PMC5894565 DOI: 10.6065/apem.2018.23.1.38] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 01/20/2018] [Accepted: 01/29/2018] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Hypothyroidism is a clinical syndrome that can lead to elevated levels of serum creatinine and uric acid by causing impaired renal function. Although many studies have been carried out on the relationship between overt hypothyroidism and renal function, few studies have been conducted on subclinical hypothyroidism and renal function, especially in pediatric patients. For this reason, we studied this issue in children, so as to provide a background for more useful research and future education. METHODS This case-control study was performed on 107 children aged 2-14 years, 56 children with subclinical hypothyroidism in the case group, and 51 healthy children in the control group presenting to Ayatollah Mousavi Hospital in Zanjan and private clinics of Zanjan city. Thyroid stimulating hormone, triiodothyronine, thyroxine, creatinine, and uric acid were measured in both groups of children after obtaining the necessary criteria for entering the study. RESULTS Compared to the control group, subjects with subclinical hypothyroidism had higher levels of creatinine (P=0.003), while serum uric acid levels in subclinical hypothyroid children was not significantly different from those in the control group (P=0.200). CONCLUSIONS In subclinical hypothyroidism in children, creatinine was higher than in euthyroid patients, but uric acid was not different.
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Affiliation(s)
- Saba Sayari
- Zanjan University of Medical Sciences, Zanjan, Zanjan University of Medical Sciences, Zanjan, Iran,Address for correspondence: Saba Sayari, MD https://orcid.org/0000-0002-7929-128X Zanjan University of medical science, Mahdavi Blvd., Zanjan, Iran Tel: +98-2433440301-3 Fax: +98-2433449553 E-mail:
| | - Ziba Molaei
- Department of Pediatrics, Ayatollah Moussavi Hospital, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Zohre Torabi
- Department of Pediatrics, Ayatollah Moussavi Hospital, Zanjan University of Medical Sciences, Zanjan, Iran
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42
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Chang YC, Chang CH, Yeh YC, Chuang LM, Tu YK. Subclinical and overt hypothyroidism is associated with reduced glomerular filtration rate and proteinuria: a large cross-sectional population study. Sci Rep 2018; 8:2031. [PMID: 29391480 PMCID: PMC5795015 DOI: 10.1038/s41598-018-19693-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 01/02/2018] [Indexed: 12/28/2022] Open
Abstract
Subclinical hypothyroidism has been associated with dyslipidemia, hypertension, and increased risk of coronary artery disease. However, limited is known for its effect on renal function. Here we aimed to investigate whether subclinical hypothyroidism is associated with reduced estimated glomerular filtration rate (eGFR) and proteinuria in the general population. A cross-sectional cohort of 74,356 adults aged ≥20 year participating in voluntary health examinations without previous thyroid diseases were recruited in Taiwan. The mean eGFR of persons with euthyroidism, subclinical, and overt hypothyroidism are 87.99, 83.46, and 72.22 mL/min/1.73 m2, respectively (P-for- trend < 0.001). The proportion of proteinuria in persons with euthyroidism, subclinical and overt hypothyroidism is 1.29%, 2.2%, and 2.97%, respectively (P-for-trend: 0.001). The odds ratio of CKD for subclinical, clinical, and all hypothyroidism is 2.04 (95% confidence interval (CI): 1.67-2.50) and 7.61 (95% CI: 4.92-11.77), and 2.41 (95% CI: 2.01–2.89), respectively as compared to euthyroidism. These odd ratios remained significant after further adjustments. The odds ratios for proteinuria is 2.04 (95% CI: 1.67–2.50), 7.61 (95% CI: 4.92–11.77), and 2.41 (95% CI: 2.01–2.89) for subclinical, clinical, and total hypothyroidism, respectively, although the odds ratios were attenuated after further adjustment. Our results suggest subclinical hypothyroidism is a novel risk factor of reduced renal function but not proteinuria.
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Affiliation(s)
- Yi-Cheng Chang
- Graduate Institute of Medical Genomics and Proteomics, National Taiwan University, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.,Institue of Biomedical Science, Academia Sinica, Taipei, Taiwan
| | - Chia Hsuin Chang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yi-Chun Yeh
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Lee-Ming Chuang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yu-Kang Tu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
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Anderson JLC, Gruppen EG, van Tienhoven-Wind L, Eisenga MF, de Vries H, Gansevoort RT, Bakker SJL, Dullaart RPF. Glomerular filtration rate is associated with free triiodothyronine in euthyroid subjects: Comparison between various equations to estimate renal function and creatinine clearance. Eur J Intern Med 2018; 48:94-99. [PMID: 29079274 DOI: 10.1016/j.ejim.2017.10.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 10/09/2017] [Accepted: 10/10/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Effects of variations in thyroid function within the euthyroid range on renal function are unclear. Cystatin C-based equations to estimate glomerular filtration rate (GFR) are currently advocated for mortality and renal risk prediction. However, the applicability of cystatin C-based equations is discouraged in patients with overt thyroid dysfunction, since serum cystatin C and creatinine levels are oppositely affected by thyroid dysfunction. Here, we compared relationships of thyroid stimulating hormone (TSH), free thyroxine (FT4) and free triiodothyronine (FT3) with various measures of kidney function in euthyroid subjects. METHODS Relationships of eGFR, based on creatinine (eGFRcrea), cystatin C (eGFRcysC), creatinine+cystatin C combined (eGFRcrea-cysC) and creatinine clearance (CrCl) with TSH, FT4 and FT3 were determined in 2180 euthyroid subjects (TSH, FT4 and FT3 all within the reference range; anti-thyroid peroxidase autoantibodies negative) who did not use thyroid hormones, anti-thyroid drugs, amiodarone or lithium carbonate. RESULTS In multivariable models including TSH, FT3 and FT4 together, eGFRcrea, eGFRcysC and eGFRcrea-cysC and CrCl were all positively related to FT3 (P≤0.001), translating into a 2.61 to 2.83mL/min/1.73m2 increase in eGFR measures and a 3.92mL/min increase in CrCl per 1pmol/L increment in FT3. These relationships with FT3 remained taking account of relevant covariates. CONCLUSIONS In euthyroid subjects renal function is associated with thyroid function status, especially by serum FT3, irrespective of the eGFR equation applied. In the euthyroid state, cystatin C-based eGFR equations are appropriate to assess the relationship of renal function with variation in thyroid function status.
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Affiliation(s)
- Josephine L C Anderson
- Department of Endocrinology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Eke G Gruppen
- Department of Endocrinology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands; Department of Nephrology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Lynnda van Tienhoven-Wind
- Department of Endocrinology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Michele F Eisenga
- Department of Nephrology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Hanne de Vries
- Department of Endocrinology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Ron T Gansevoort
- Department of Nephrology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Stephan J L Bakker
- Department of Nephrology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Robin P F Dullaart
- Department of Endocrinology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands.
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Chen Y, Wu G, Xu M. The effect of L-thyroxine substitution on oxidative stress in early-stage diabetic nephropathy patients with subclinical hypothyroidism: a randomized double-blind and placebo-controlled study. Int Urol Nephrol 2017; 50:97-103. [PMID: 29196928 DOI: 10.1007/s11255-017-1756-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 11/20/2017] [Indexed: 12/29/2022]
Abstract
PURPOSE To study oxidative stress status of early type 2 diabetic nephropathy (DN) patients with subclinical hypothyroidism (SCH) and to assess effect of L-thyroxine therapy on the oxidative stress in these patients. METHODS It is a randomized double-blind and placebo-controlled trial. A total of 48 patients with early type 2 DN were included as Euthyroid group, and 92 early type 2 DN with SCH were selected and randomly assigned to L-thyroxine treatment group (LT4 group) and placebo group (SCH group). Changes in urinary albumin excretion rate (UAER), serum malondialdehyde (MDA), superoxide dismutase (SOD) activity, urine 8-hydroxyl deoxyguanosine (8-OHdG), serum creatinine, estimated glomerular filtration rate, and lipid profile before and after 24 weeks of follow-up were examined and compared. RESULTS The levels of UAER, MDA, 8-OHdG were higher, while the SOD activity was lower in DN patients with SCH than in DN patients (p < 0.05 for all). In the LT4 group, the levels of UAER, MDA, 8-OHdG decreased significantly (p < 0.05) to levels no longer different from the Euthyroid group. The SOD activity increased significantly. But in SCH group, the levels of mAlb, MDA, 8-OHdG were greater after 24 weeks of follow-up and greater than patients in the Euthyroid group. SOD activity decreased significantly after 24 weeks in the SCH group (p < 0.05). CONCLUSION Oxidative stress is greater in the DN patients with SCH, and SCH may exacerbate kidney injury in early DN patients. The LT4 treatment may decrease the oxidative stress and attenuate renal injury in DN patient with SCH.
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Affiliation(s)
- Yong Chen
- Department of Nephropathy, Xianning Central Hospital, The First Affiliated Hospital of Hubei University of Science and Technology, 228 Jingui Road, Xianning, 437100, China
| | - Ganlin Wu
- Department of Medicine, School of Clinical Medicine Sciences, Hubei University of science and Technology, 88 Xianning Road, Xianning, 437100, China.
| | - Meirong Xu
- Department of Medicine, The Second Affiliated Hospital of Hubei University of Science and Technology, 58 Chahua Road, Xianning, 437100, China
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Schultheiss UT, Daya N, Grams ME, Seufert J, Steffes M, Coresh J, Selvin E, Köttgen A. Thyroid function, reduced kidney function and incident chronic kidney disease in a community-based population: the Atherosclerosis Risk in Communities study. Nephrol Dial Transplant 2017; 32:1874-1881. [PMID: 27540046 PMCID: PMC5837276 DOI: 10.1093/ndt/gfw301] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 07/12/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Reduced kidney function is a common public health problem that increases risk for a wide variety of adverse outcomes, making the identification of potentially modifiable factors associated with the development of incident chronic kidney disease (CKD) important. Alterations in the hypothalamic-pituitary-thyroid axis have been linked to reduced kidney function, but the association of thyroid function with the development of incident CKD is largely uncharacterized. METHODS Concentrations of thyroid stimulating hormone (TSH), free thyroxine (FT4), triiodothyronine (T3) and thyroid peroxidase antibody (TPOAb) were quantified in 12 785 black and white participants of the ongoing community-based prospective Atherosclerosis Risk in Communities study. Thyroid markers and clinical categories of thyroid dysfunction (euthyroidism, combined subclinical and overt hypothyroidism, combined subclinical and overt hyperthyroidism) were also evaluated for their association with reduced kidney function (estimated glomerular filtration rate <60 mL/min/1.73 m2) at study baseline and with incident CKD over a median follow-up time of 19.6 years. RESULTS Higher TSH and FT4 as well as lower T3 concentrations were strongly and independently associated with reduced kidney function at study baseline. The clinical entities hypothyroidism and hyperthyroidism were also associated with higher odds of baseline reduced kidney function, but this was not significant. However, none of the markers of thyroid function nor different clinical categories of thyroid dysfunction (hypothyroidism, hyperthyroidism or TPOAb positivity) were associated with incident CKD in adjusted analyses. CONCLUSIONS Elevated TSH, FT4 and reduced T3 concentrations were associated with reduced kidney function cross-sectionally. The lack of association with the development of incident CKD suggests that altered thyroid function in the general population is not causally related to CKD development, but screening for thyroidal status may be especially relevant in persons with reduced kidney function.
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Affiliation(s)
- Ulla T Schultheiss
- Renal Division, Department of Medicine IV, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Division of Genetic Epidemiology, Institute of Medical Biometry and Statistics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Natalie Daya
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Morgan E Grams
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Division of Nephrology, Johns Hopkins University, Baltimore, MD, USA
| | - Jochen Seufert
- Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael Steffes
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Anna Köttgen
- Renal Division, Department of Medicine IV, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Division of Genetic Epidemiology, Institute of Medical Biometry and Statistics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Peixoto de Miranda ÉJF, Bittencourt MS, Goulart AC, Santos IS, de Oliveira Titan SM, Ladeira RM, Barreto SM, Lotufo PA, Benseñor IJM. Thyrotropin levels are associated with chronic kidney disease among healthy subjects in cross-sectional analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Clin Exp Nephrol 2017; 21:1035-1043. [PMID: 28349231 DOI: 10.1007/s10157-017-1400-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 03/03/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Few studies have evaluated a possible relationship between thyrotropin levels and glomerular filtration rate (GFR) and albumin/creatinine ratio in euthyroid subjects. We aimed to analyze this association using baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). METHODS Cross-sectionally, we included subjects with normal thyroid function and with subclinical hypothyroidism (SCH). We excluded individuals using medications that affect thyroid function. Linear and logistic regression models evaluated GFR estimated by Chronic Kidney Disease Epidemiology Collaboration (CKD-Epi) and albuminuria/creatinine ratio as dependent variables and thyrotropin quartiles in individuals with euthyroidism and SCH as independent variables, adjusted for demographical characteristics and diseases related to CKD. RESULTS We included 13,193 subjects with a median age of 51 years [interquartile range, (IQR): 45-58], 6840 (51.8%) women, 12,416 (94.1%) euthyroid, and 777 (5.9%) with SCH. SCH subjects were characterized by higher age, triglycerides, frequency of white race, cardiovascular disease, CKD, and former smokers. In adjusted models, log-transformed TSH in euthyroid subjects was inversely and strongly associated with CKD (β = -2.181, 95% CI -2.714 to -1.648), P < 0.0001 for glomerular filtration rate and 4.528 (1.190-7.865) for albuminuria/creatinine ratio. Multivariate logistic models for euthyroid subjects showed an OR of 1.45 (95% CI 1.15-1.83) for GFR and of 1.95 (95% CI 1.08-3.54) for albuminuria/creatinine ratio in the fourth quartile of TSH using the first as the reference. CONCLUSIONS Thyrotropin levels are independently associated with CKD in euthyroid subjects.
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Affiliation(s)
- Érique José F Peixoto de Miranda
- Centro de Pesquisa Clínica, Hospital Universitário, Universidade de São Paulo, Av. Lineu Prestes 2565, 3rd floor, São Paulo, SP, CEP 05508-000, Brazil
| | - Márcio Sommer Bittencourt
- Centro de Pesquisa Clínica, Hospital Universitário, Universidade de São Paulo, Av. Lineu Prestes 2565, 3rd floor, São Paulo, SP, CEP 05508-000, Brazil
| | - Alessandra C Goulart
- Centro de Pesquisa Clínica, Hospital Universitário, Universidade de São Paulo, Av. Lineu Prestes 2565, 3rd floor, São Paulo, SP, CEP 05508-000, Brazil
| | - Itamar S Santos
- Centro de Pesquisa Clínica, Hospital Universitário, Universidade de São Paulo, Av. Lineu Prestes 2565, 3rd floor, São Paulo, SP, CEP 05508-000, Brazil
| | - Silvia Maria de Oliveira Titan
- Divisão de Nefrologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, Cerqueira César, São Paulo, CEP: 05403-000, Brazil
| | - Roberto Marini Ladeira
- Secretaria Municipal de Saúde de Belo Horizonte, Avenida Afonso Pena, 2336, Funcionários, Belo Horizonte, CEP 30130-007, Brazil.,Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Alfredo Balena, 190, Belo Horizonte, CEP 30320050, Brazil
| | - Sandhi Maria Barreto
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Alfredo Balena, 190, Belo Horizonte, CEP 30320050, Brazil
| | - Paulo A Lotufo
- Centro de Pesquisa Clínica, Hospital Universitário, Universidade de São Paulo, Av. Lineu Prestes 2565, 3rd floor, São Paulo, SP, CEP 05508-000, Brazil
| | - Isabela Judith Martins Benseñor
- Centro de Pesquisa Clínica, Hospital Universitário, Universidade de São Paulo, Av. Lineu Prestes 2565, 3rd floor, São Paulo, SP, CEP 05508-000, Brazil.
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47
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Abstract
Thyroid hormones influence renal development, kidney hemodynamics, glomerular filtration rate and sodium and water homeostasis. Hypothyroidism and hyperthyroidism affect renal function by direct renal effects as well as systemic hemodynamic, metabolic and cardiovascular effects. Hypothyroidism has been associated with increased serum creatinine and decreased glomerular filtration rate. The reverse effects have been reported in thyrotoxicosis. Most of renal manifestations of thyroid dysfunction are reversible with treatment. Kidney disease may also cause thyroid dysfunction by several mechanisms. Nephrotic syndrome has been associated to changes in serum thyroid hormone concentrations. Different forms of glomerulonephritis and tubulointerstitial disease may be linked to thyroid derangements. A high prevalence of thyroid hormone alteration has been reported in acute kidney injury. Thyroid dysfunction is highly prevalent in chronic kidney disease patients. Subclinical hypothyroidism and low triiodothyronine syndrome are common features in patients with chronic kidney disease. Patients treated by both hemodialysis and peritoneal dialysis, and renal transplantation recipients, exhibit thyroid hormone alterations and thyroid disease with higher frequency than that found in the general population. Drugs used in the therapy of thyroid disease may lead to renal complications and, similarly, drugs used in kidney disorders may be associated to thyroid alterations. Lastly, low thyroid hormones, especially low triiodothyronine levels, in patients with chronic kidney disease have been related to a higher risk of cardiovascular disease and all-cause mortality. Interpretation of the interactions between thyroid and renal function is a challenge for clinicians involved in the treatment of patients with thyroid and kidney disease.
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Affiliation(s)
- Pedro Iglesias
- Department of Endocrinology, Hospital Ramón y Cajal, Ctra. De Colmenar, Km 9,100, 28034, Madrid, Spain.
| | - María Auxiliadora Bajo
- Department of Nephrology, Hospital La Paz, Madrid, Spain
- Department of Health Sciences, Universidad Autónoma de Madrid, Madrid, Spain
| | - Rafael Selgas
- Department of Nephrology, Hospital La Paz, Madrid, Spain
- Department of Health Sciences, Universidad Autónoma de Madrid, Madrid, Spain
| | - Juan José Díez
- Department of Endocrinology, Hospital Ramón y Cajal, Ctra. De Colmenar, Km 9,100, 28034, Madrid, Spain
- Department of Medicine, University de Alcalá de Henares, Madrid, Spain
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Lucy JM, Peterson ME, Randolph JF, Scrivani PV, Rishniw M, Davignon DL, Thompson MS, Scarlett JM. Efficacy of Low-dose (2 millicurie) versus Standard-dose (4 millicurie) Radioiodine Treatment for Cats with Mild-to-Moderate Hyperthyroidism. J Vet Intern Med 2017; 31:326-334. [PMID: 28158908 PMCID: PMC5354058 DOI: 10.1111/jvim.14646] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 09/18/2016] [Accepted: 11/29/2016] [Indexed: 12/02/2022] Open
Abstract
Background Radioiodine (131I) is effective treatment for hyperthyroidism in cats, but optimal dose to restore euthyroidism without inducing hypothyroidism is unclear. Treatment‐induced hypothyroidism can lead to azotemia and reduced duration of survival. Objective To compare efficacy and short‐term outcomes of low‐dose 131I versus higher, standard‐dose 131I as treatment for hyperthyroidism. Animals A total of 189 client‐owned cats undergoing 131I treatment for mild‐to‐moderate hyperthyroidism (serum T4 ≥ 4.0 μg/dL and <13.0 μg/dL). Methods Prospective, nonrandomized, cohort study comparing treatment with either low‐dose (2 mCi, n = 150) or standard‐dose (4 mCi, n = 39) 131I. Serum T4, thyroid‐stimulating hormone (TSH), and creatinine concentrations were measured after 1, 3, and 6 months to determine persistent hyperthyroidism, overt hypothyroidism (low T4, high TSH), subclinical hypothyroidism (normal T4, high TSH), and azotemia. Results There was no significant difference in prevalence of cats with persistent hyperthyroidism between standard‐ and low‐dose treatment groups at 3 (0% versus 5.3%; P = .34) and 6 (0% versus 3.3%; P = .51) months. Overt (18% versus 1%; P = .0005) or subclinical (46% versus 21%; P = .004) hypothyroidism was more common in cats at 6 months after standard‐dose 131I. No difference in incidence of azotemia existed between groups, but cats treated with standard‐dose 131I had higher creatinine concentrations (P < .05) and higher percent rises in creatinine (P < .0001). Conclusions and Clinical Importance Low‐dose 131I is safe and effective for cats with mild‐to‐moderate hyperthyroidism, as evidenced by a cure rate of >95% with reduced frequency of iatrogenic hypothyroidism and azotemia.
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Affiliation(s)
- J M Lucy
- Departments of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY
| | | | - J F Randolph
- Departments of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY
| | - P V Scrivani
- Departments of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY
| | - M Rishniw
- Departments of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY
| | - D L Davignon
- Departments of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY
| | - M S Thompson
- Departments of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY
| | - J M Scarlett
- Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY
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49
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Chaker L, Sedaghat S, Hoorn EJ, Elzen WPJD, Gussekloo J, Hofman A, Ikram MA, Franco OH, Dehghan A, Peeters RP. The association of thyroid function and the risk of kidney function decline: a population-based cohort study. Eur J Endocrinol 2016; 175:653-660. [PMID: 27926474 DOI: 10.1530/eje-16-0537] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 09/02/2016] [Accepted: 09/29/2016] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Thyroid dysfunction has been associated with kidney function decline, but mainly in cross-sectional studies. Therefore, we aimed to determine the association between thyroid and kidney function in a prospective population-based cohort study longitudinally. DESIGN Prospective cohort study. METHODS Participants aged ≥45 years from the Rotterdam Study with thyroid and kidney function assessment were included. Kidney function and new onset chronic kidney disease (CKD) were defined using estimated glomerular filtration ate (eGFR), with CKD defined as eGFR <60 mL/min/1.73 m2 according to the CKD-EPI formula. RESULTS We included 5103 participants (mean age of 63.6 years) with a mean follow-up of 8.1 years. Cross-sectionally, higher TSH levels were associated with lower eGFR (Beta (β): -1.75 mL/min; 95% confidence interval (CI): -2.17, -1.33), in multivariable models adjusting for several cardiovascular risk factors including smoking, hypertension and history of coronary heart disease among others. In contrast, longitudinally, higher TSH levels were associated with less annual eGFR decline (β: -0.06 mL/min; CI: -0.11, -0.01) and lower CKD incidence (odds ratio 0.85, CI; 0.75, 0.96). Compared with euthyroid participants, subclinical hyperthyroid individuals had an increased risk for CKD whereas hypothyroid individuals had a decreased risk (P for trend = 0.04). CONCLUSIONS Hyperactive thyroid function is associated with increased risk of kidney function decline while hypothyroidism is associated with a decreased CKD risk. More insight is needed in the pathophysiological pathways connecting high thyroid function and kidney function decline.
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Affiliation(s)
- Layal Chaker
- Rotterdam Thyroid Center
- Department of Internal Medicine
- Department of EpidemiologyErasmus University Medical Center, Rotterdam, The Netherlands
| | - Sanaz Sedaghat
- Department of EpidemiologyErasmus University Medical Center, Rotterdam, The Netherlands
| | | | | | - Jacobijn Gussekloo
- Department of Public Health and Primary CareLeiden University Medical Center, Leiden, The Netherlands
| | - Albert Hofman
- Department of EpidemiologyErasmus University Medical Center, Rotterdam, The Netherlands
- Harvard T H Chan School of Public HealthBoston, Massachusetts, USA
| | - M Arfan Ikram
- Department of EpidemiologyErasmus University Medical Center, Rotterdam, The Netherlands
- Department of NeurologyErasmus University Medical Center, Rotterdam, The Netherlands
| | - Oscar H Franco
- Department of EpidemiologyErasmus University Medical Center, Rotterdam, The Netherlands
| | - Abbas Dehghan
- Department of EpidemiologyErasmus University Medical Center, Rotterdam, The Netherlands
| | - Robin P Peeters
- Rotterdam Thyroid Center
- Department of Internal Medicine
- Department of EpidemiologyErasmus University Medical Center, Rotterdam, The Netherlands
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50
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Abstract
PURPOSE OF REVIEW Hypothyroidism is highly prevalent in chronic kidney disease (CKD) patients, including those receiving dialysis. This review examines potential mechanistic links between thyroid and kidney disease; current evidence for hypothyroidism as a risk factor for de novo CKD and CKD progression; and studies of thyroid functional disorders, cardiovascular disease, and death in the CKD population. RECENT FINDINGS Epidemiologic data have demonstrated an incrementally higher prevalence of hypothyroidism with increasing severity of kidney dysfunction. Various thyroid functional test abnormalities are also commonly observed in CKD due to alterations in thyroid hormone synthesis, metabolism, and regulation. Although the mechanistic link between thyroid and kidney disease remains unclear, observational studies suggest that hypothyroidism is associated with abnormal kidney structure and function. Previously thought to be a physiologic adaptation, recent studies show that hypothyroidism is associated with higher risk of cardiovascular disease and death in CKD. SUMMARY A growing body of evidence suggests that hypothyroidism is a risk factor for incident CKD, CKD progression, and higher death risk in kidney disease patients. Rigorous studies are needed to determine the impact of thyroid hormone replacement upon kidney disease progression, cardiovascular disease, and mortality, which may shed light onto the causal implications of hypothyroidism in CKD.
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Affiliation(s)
- Connie M Rhee
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine School of Medicine, Orange, California, United States
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