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Thorkildsen MS, Mohus RM, Åsvold BO, Skei NV, Nilsen TIL, Solligård E, Damås JK, Gustad LT. Thyroid function and risk of bloodstream infections: Results from the Norwegian prospective population-based HUNT Study. Clin Endocrinol (Oxf) 2022; 96:896-906. [PMID: 34951039 DOI: 10.1111/cen.14658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 10/14/2021] [Accepted: 12/05/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Previous studies on thyroid function and risk of infection is conflicting and often stem from intensive care cohorts were nonthyroidal illness syndrome (NTIS) may be present. The objective of this study was to identify the risk of bloodstream infections (BSI) and BSI-related mortality with thyroid-stimulating hormone (TSH) levels within the reference range in a general population. DESIGN Prospective follow-up. PARTICIPANTS The HUNT2 (1995-97) included 34,619 participants with information on TSH levels. MEASUREMENTS Hazard ratios (HRs) with 95% confidence interval (CI) confirmed BSIs and BSI-related mortality until 2011. RESULTS During a median follow-up of 14.5 years, 1179 experienced at least one episode of BSI and 208 died within 30 days after a BSI. TSH levels within the reference range of 0.5-4.5 mU/L were not associated with the risk of first-time BSI, with an HR of 0.97 (95% CI: 0.90-1.04) per mU/L. Stratified by baseline age < or ≥65 years, TSH was inversely associated with the risk of BSI (HR: 0.88; 95% CI: 0.78-1.00 per mU/L) in the youngest age group only. Persons with any baseline thyroid disease had a 30% risk and the hyperthyroid subgroup a 57%, and hypothyroidism a 20% increased risk of BSI. TSH levels were not clearly associated with BSI mortality, but the HRs were imprecise due to few BSI-related deaths. CONCLUSION There was some evidence of a weak inverse association between TSH levels and the risk of BSI in persons below 65 years of age. The increased risk seen in persons with thyroid illness is probably explained by confounding by concurrent ill health.
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Affiliation(s)
- Marianne S Thorkildsen
- Gemini Center for Sepsis Research at Institute of Circulation and Medical Imaging, NTNU, Trondheim, Norway
| | - Randi M Mohus
- Gemini Center for Sepsis Research at Institute of Circulation and Medical Imaging, NTNU, Trondheim, Norway
- Clinic of Anesthesia and Intensive Care, St. Olavs Hospital, Trondheim, Norway
| | - Bjørn O Åsvold
- Department of Public Health and Nursing, K.G. Jebsen Center for Genetic Epidemiology, NTNU, Trondheim, Norway
- Department of Endocrinology, Clinic of Medicine, St. Olavs Hospital, Trondheim, Norway
- Department of Public Health and Nursing, HUNT Research Centre , NTNU, Levanger, Norway
| | - Nina V Skei
- Gemini Center for Sepsis Research at Institute of Circulation and Medical Imaging, NTNU, Trondheim, Norway
- Department of Anesthesia and Intensive Care, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Tom I L Nilsen
- Clinic of Anesthesia and Intensive Care, St. Olavs Hospital, Trondheim, Norway
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Erik Solligård
- Gemini Center for Sepsis Research at Institute of Circulation and Medical Imaging, NTNU, Trondheim, Norway
- Clinic of Anesthesia and Intensive Care, St. Olavs Hospital, Trondheim, Norway
| | - Jan K Damås
- Gemini Center for Sepsis Research at Institute of Circulation and Medical Imaging, NTNU, Trondheim, Norway
- Centre of Molecular Inflammation Research, NTNU, Trondheim, Norway
- Department of Clinical and Molecular Medicine, NTNU, Trondheim, Norway
- Department of Infectious Diseases, St. Olavs Hospital, Trondheim, Norway
| | - Lise T Gustad
- Gemini Center for Sepsis Research at Institute of Circulation and Medical Imaging, NTNU, Trondheim, Norway
- Clinic of Medicine and Rehabilitation, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
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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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Suda S, Aoki J, Shimoyama T, Suzuki K, Sakamoto Y, Katano T, Okubo S, Nito C, Nishiyama Y, Mishina M, Kimura K. Low Free Triiodothyronine at Admission Predicts Poststroke Infection. J Stroke Cerebrovasc Dis 2017; 27:397-403. [PMID: 29031498 DOI: 10.1016/j.jstrokecerebrovasdis.2017.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 08/11/2017] [Accepted: 09/11/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Poststroke infection (PSI) is common and is usually associated with a severe prognosis. We investigated the association between PSI and thyroid hormones, which are critical to immune regulation, in patients with acute stroke. METHODS We retrospectively enrolled 520 consecutive patients with acute ischemic stroke (326 men; age, 71.9 ± 13.2 years) admitted to our department between September 2014 and June 2016. The impact of serum thyroid hormone levels measured at admission (thyroid-stimulating hormone [TSH], free triiodothyronine [FT3], and free thyroxine [FT4]) on the PSI was evaluated using multivariate logistic regression analysis. RESULTS We diagnosed 107 patients (20.6%; pneumonia, 65; urinary tract infection, 19; others, 23) with PSIs. While age (P <.001), body mass index (P = .0012), preadmission modified Rankin scale score (P = .0001), National Institutes of Health Stroke Scale score on admission (P <.001), admission FT3 level (P <.001), atrial fibrillation (P <.001), and ischemic heart disease (P = .0451) were significantly associated with PSI, we found no relationship among TSH levels, FT4 levels, and PSI occurrence. After multivariate adjustment, patients with PSIs were more frequently in the Q1 quartile (≤2.25 pg/mL) than in the Q2 (2.26-2.55 pg/mL; P = .0251), Q3 (2.56-2.89 pg/mL; P = .0007), or Q4 (≥2.90 pg/mL; P = .0010) quartiles of FT3 levels. Moreover, low FT3 levels (<2.29 pg/mL) were independently associated with PSI occurrence (P = .0013). CONCLUSIONS Low FT3 levels at admission are independently associated with PSI occurrence.
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Affiliation(s)
- Satoshi Suda
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
| | - Junya Aoki
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Takashi Shimoyama
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Kentaro Suzuki
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Yuki Sakamoto
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Takehiro Katano
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Seiji Okubo
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Chikako Nito
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Yasuhiro Nishiyama
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Masahiro Mishina
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Kazumi Kimura
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
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Rhee CM, Ravel VA, Streja E, Mehrotra R, Kim S, Wang J, Nguyen DV, Kovesdy CP, Brent GA, Kalantar-Zadeh K. Thyroid Functional Disease and Mortality in a National Peritoneal Dialysis Cohort. J Clin Endocrinol Metab 2016; 101:4054-4061. [PMID: 27525529 PMCID: PMC5095247 DOI: 10.1210/jc.2016-1691] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
CONTEXT AND OBJECTIVE End-stage renal disease patients have a higher risk of thyroid disease compared with those without kidney disease. Although thyroid dysfunction is associated with higher death risk in the general population and those undergoing hemodialysis, little is known about the effect of thyroid disease upon mortality in patients treated with peritoneal dialysis (PD). DESIGN, SETTING, PARTICIPANTS, AND MAIN OUTCOME We examined the association of thyroid status, assessed by serum TSH, with all-cause mortality among PD patients from a large national dialysis organization who underwent one or more TSH measurements over 5 years (January 2007 to December 2011). Thyroid status was categorized as overt-hyperthyroid, subclinical-hyperthyroid, low-normal, high-normal, subclinical-hypothyroid, and overt-hypothyroid range (TSH < 0.1, 0.1–<0.5, 0.5–<3.0, 3.0–<5.0, 5.0–<10.0, and ≥10.0 mIU/L, respectively). We examined the association between TSH and mortality using case mix–adjusted time-dependent Cox models to assess short-term thyroid function–mortality associations and to account for changes in thyroid function over time. RESULTS Among 1484 patients, 7 and 18% had hyperthyroidism and hypothyroidism, respectively, at baseline. We found that both lower and higher time-dependent TSH levels were associated with higher mortality (reference: TSH, 0.5-<3.0 mIU/L): adjusted hazard ratios (95% confidence intervals) 2.09 (1.08-4.06), 1.53 (0.87-2.70), 1.05 (0.75-1.46), 1.63 (1.11-2.40), and 3.11 (2.08-4.63) for TSH levels, <0.1, 0.1-<0.5, 0.5-<3.0, 3.0-<5.0, 5.0-<10.0, and ≥10.0 mIU/L, respectively. CONCLUSION Time-dependent TSH levels < 0.1 mIU/L and ≥ 5.0 mIU/L were associated with higher mortality, suggesting hyper- and hypothyroidism carry short-term risk in PD patients. Additional studies are needed to determine mechanisms underlying the thyroid dysfunction-mortality association, and whether normalization of TSH with treatment ameliorates mortality in this population.
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Affiliation(s)
- Connie M Rhee
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension (C.M.R., V.A.R., E.S., J.W., K.K.-Z.), University of California-Irvine, Orange, California 92868; Kidney Research Institute and Harborview Medical Center, Division of Nephrology (R.M.), University of Washington, Seattle, Washington 98195; Department of Mathematics and Statistics (S.K.), California State University-Monterey Bay, Seaside, California 93955; Department of Medicine (D.V.N.), University of California-Irvine, Orange, California 92868; University of Tennessee Health Science Center (C.P.K.), Memphis, Tennessee 38163; Memphis Veterans Affairs Medical Center (C.P.K.), Memphis, Tennessee 38104; and Department of Medicine (G.A.B.), David Geffen School of Medicine at UCLA, Los Angeles, California 90095
| | - Vanessa A Ravel
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension (C.M.R., V.A.R., E.S., J.W., K.K.-Z.), University of California-Irvine, Orange, California 92868; Kidney Research Institute and Harborview Medical Center, Division of Nephrology (R.M.), University of Washington, Seattle, Washington 98195; Department of Mathematics and Statistics (S.K.), California State University-Monterey Bay, Seaside, California 93955; Department of Medicine (D.V.N.), University of California-Irvine, Orange, California 92868; University of Tennessee Health Science Center (C.P.K.), Memphis, Tennessee 38163; Memphis Veterans Affairs Medical Center (C.P.K.), Memphis, Tennessee 38104; and Department of Medicine (G.A.B.), David Geffen School of Medicine at UCLA, Los Angeles, California 90095
| | - Elani Streja
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension (C.M.R., V.A.R., E.S., J.W., K.K.-Z.), University of California-Irvine, Orange, California 92868; Kidney Research Institute and Harborview Medical Center, Division of Nephrology (R.M.), University of Washington, Seattle, Washington 98195; Department of Mathematics and Statistics (S.K.), California State University-Monterey Bay, Seaside, California 93955; Department of Medicine (D.V.N.), University of California-Irvine, Orange, California 92868; University of Tennessee Health Science Center (C.P.K.), Memphis, Tennessee 38163; Memphis Veterans Affairs Medical Center (C.P.K.), Memphis, Tennessee 38104; and Department of Medicine (G.A.B.), David Geffen School of Medicine at UCLA, Los Angeles, California 90095
| | - Rajnish Mehrotra
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension (C.M.R., V.A.R., E.S., J.W., K.K.-Z.), University of California-Irvine, Orange, California 92868; Kidney Research Institute and Harborview Medical Center, Division of Nephrology (R.M.), University of Washington, Seattle, Washington 98195; Department of Mathematics and Statistics (S.K.), California State University-Monterey Bay, Seaside, California 93955; Department of Medicine (D.V.N.), University of California-Irvine, Orange, California 92868; University of Tennessee Health Science Center (C.P.K.), Memphis, Tennessee 38163; Memphis Veterans Affairs Medical Center (C.P.K.), Memphis, Tennessee 38104; and Department of Medicine (G.A.B.), David Geffen School of Medicine at UCLA, Los Angeles, California 90095
| | - Steven Kim
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension (C.M.R., V.A.R., E.S., J.W., K.K.-Z.), University of California-Irvine, Orange, California 92868; Kidney Research Institute and Harborview Medical Center, Division of Nephrology (R.M.), University of Washington, Seattle, Washington 98195; Department of Mathematics and Statistics (S.K.), California State University-Monterey Bay, Seaside, California 93955; Department of Medicine (D.V.N.), University of California-Irvine, Orange, California 92868; University of Tennessee Health Science Center (C.P.K.), Memphis, Tennessee 38163; Memphis Veterans Affairs Medical Center (C.P.K.), Memphis, Tennessee 38104; and Department of Medicine (G.A.B.), David Geffen School of Medicine at UCLA, Los Angeles, California 90095
| | - Jiaxi Wang
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension (C.M.R., V.A.R., E.S., J.W., K.K.-Z.), University of California-Irvine, Orange, California 92868; Kidney Research Institute and Harborview Medical Center, Division of Nephrology (R.M.), University of Washington, Seattle, Washington 98195; Department of Mathematics and Statistics (S.K.), California State University-Monterey Bay, Seaside, California 93955; Department of Medicine (D.V.N.), University of California-Irvine, Orange, California 92868; University of Tennessee Health Science Center (C.P.K.), Memphis, Tennessee 38163; Memphis Veterans Affairs Medical Center (C.P.K.), Memphis, Tennessee 38104; and Department of Medicine (G.A.B.), David Geffen School of Medicine at UCLA, Los Angeles, California 90095
| | - Danh V Nguyen
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension (C.M.R., V.A.R., E.S., J.W., K.K.-Z.), University of California-Irvine, Orange, California 92868; Kidney Research Institute and Harborview Medical Center, Division of Nephrology (R.M.), University of Washington, Seattle, Washington 98195; Department of Mathematics and Statistics (S.K.), California State University-Monterey Bay, Seaside, California 93955; Department of Medicine (D.V.N.), University of California-Irvine, Orange, California 92868; University of Tennessee Health Science Center (C.P.K.), Memphis, Tennessee 38163; Memphis Veterans Affairs Medical Center (C.P.K.), Memphis, Tennessee 38104; and Department of Medicine (G.A.B.), David Geffen School of Medicine at UCLA, Los Angeles, California 90095
| | - Csaba P Kovesdy
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension (C.M.R., V.A.R., E.S., J.W., K.K.-Z.), University of California-Irvine, Orange, California 92868; Kidney Research Institute and Harborview Medical Center, Division of Nephrology (R.M.), University of Washington, Seattle, Washington 98195; Department of Mathematics and Statistics (S.K.), California State University-Monterey Bay, Seaside, California 93955; Department of Medicine (D.V.N.), University of California-Irvine, Orange, California 92868; University of Tennessee Health Science Center (C.P.K.), Memphis, Tennessee 38163; Memphis Veterans Affairs Medical Center (C.P.K.), Memphis, Tennessee 38104; and Department of Medicine (G.A.B.), David Geffen School of Medicine at UCLA, Los Angeles, California 90095
| | - Gregory A Brent
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension (C.M.R., V.A.R., E.S., J.W., K.K.-Z.), University of California-Irvine, Orange, California 92868; Kidney Research Institute and Harborview Medical Center, Division of Nephrology (R.M.), University of Washington, Seattle, Washington 98195; Department of Mathematics and Statistics (S.K.), California State University-Monterey Bay, Seaside, California 93955; Department of Medicine (D.V.N.), University of California-Irvine, Orange, California 92868; University of Tennessee Health Science Center (C.P.K.), Memphis, Tennessee 38163; Memphis Veterans Affairs Medical Center (C.P.K.), Memphis, Tennessee 38104; and Department of Medicine (G.A.B.), David Geffen School of Medicine at UCLA, Los Angeles, California 90095
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension (C.M.R., V.A.R., E.S., J.W., K.K.-Z.), University of California-Irvine, Orange, California 92868; Kidney Research Institute and Harborview Medical Center, Division of Nephrology (R.M.), University of Washington, Seattle, Washington 98195; Department of Mathematics and Statistics (S.K.), California State University-Monterey Bay, Seaside, California 93955; Department of Medicine (D.V.N.), University of California-Irvine, Orange, California 92868; University of Tennessee Health Science Center (C.P.K.), Memphis, Tennessee 38163; Memphis Veterans Affairs Medical Center (C.P.K.), Memphis, Tennessee 38104; and Department of Medicine (G.A.B.), David Geffen School of Medicine at UCLA, Los Angeles, California 90095
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Xu H, Brusselaers N, Lindholm B, Zoccali C, Carrero JJ. Thyroid Function Test Derangements and Mortality in Dialysis Patients: A Systematic Review and Meta-analysis. Am J Kidney Dis 2016; 68:923-932. [PMID: 27596516 DOI: 10.1053/j.ajkd.2016.06.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 06/29/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND We evaluated current evidence associating thyroid function test result derangements with risk for mortality in patients with chronic kidney failure treated by long-term dialysis. STUDY DESIGN Systematic review and meta-analysis of cohort studies. SETTING & POPULATION Dialysis patients. SELECTION CRITERIA FOR STUDIES We searched PubMed, Web of Science, Science Citation Index, Cochrane Library, and Embase databases from inception through December 2015. PREDICTORS Hypothyroidism (thyrotropin level greater than reference range) and low triiodothyronine (T3) and thyroxine (T4) levels. OUTCOMES All-cause and cardiovascular mortality. RESULTS 12 studies involving 14,766 participants (4,450 deaths) were identified. Of those, 6 studies provided data for cardiovascular mortality (2,772 participants with 327 cardiovascular deaths). Overall, confidence in the available evidence was moderate. Pooled adjusted HRs for all-cause mortality associated with hypothyroidism, low T3 level, and low T4 level were 1.24 (95% CI, 1.14-1.34), 1.67 (95% CI, 1.23-2.27), and 2.40 (95% CI, 1.47-3.93), respectively. Pooled adjusted HRs for cardiovascular mortality associated with low T3 and T4 levels were 1.84 (95% CI, 1.24-2.74) and 3.06 (95% CI, 1.29-7.24), respectively. LIMITATIONS Fewer studies reporting on T4 and thyrotropin outcomes. CONCLUSIONS In patients treated with long-term dialysis, (cardiovascular) mortality is consistently higher in the presence of thyroid function test result derangements.
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Affiliation(s)
- Hong Xu
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Division of Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Nele Brusselaers
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Bengt Lindholm
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Division of Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Carmine Zoccali
- Division of Nephrology, Dialysis and Kidney Transplantation, CNR Hospital, Reggio Calabria, Italy
| | - Juan Jesús Carrero
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Division of Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
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