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

J-shaped association of free triiodothyronine to free thyroxine ratio with 5-year mortality among patients with chronic kidney disease: a prospective cohort study

PURPOSE

To investigate the association of free triiodothyronine to free thyroxine (FT3/FT4) ratio with 5-year mortality in patients with chronic kidney disease (CKD) using data from the National Health and Nutrition Examination Survey (NHANES) through 2001-2002 and 2007-2012.

METHODS

Two thousand four hundred twenty-four patients with CKD stage 1-5 were included. Patients' baseline characteristics were collected. Cox proportional hazards models were used to investigate the association of FT3/FT4 ratio with 5-year all-cause and cardiovascular mortality. Subgroup analysis was performed.

RESULTS

Within 5 years of follow-up duration, 425 (17.53%) deaths were recorded, and 154 patients died from cardiovascular disease. A J-shaped association between FT3/FT4 ratio and 5-year mortality was observed. After fully adjustment, the elevated FT3/FT4 ratio was significantly associated with a decreased 5-year all-cause mortality risk (HR: 0.79, 95% CI 0.63-0.99) among patients with CKD stage 1-5 when FT3/FT4 ratio < 4.71, and is significantly associated with an increased 5-year all-cause mortality risk in CKD patients with advanced CKD stages or low UACR when FT3/FT4 ratio ≥ 4.71 (HR: 2.74, 95% CI 1.20-6.29; HR: 3.09, 95% CI 1.12-8.57, respectively). The elevated FT3/FT4 ratio also showed a J-shaped association with the 5-year cardiovascular mortality which disappears after fully adjustment.

CONCLUSION

The FT3/FT4 ratio is closely associated with 5-year mortality risk among patients with CKD, indicating a potential role of FT3/FT4 ratio as a biomarker for mortality prediction in CKD patients.

Low T3 syndrome as a predictor of poor outcomes in patients with follicular lymphoma

The aim of this study was to investigate the prognostic value of low T3 syndrome in follicular lymphoma (FL). A total of 221 FL patients with detailed serum thyroid hormone levels and other complete clinical data were enrolled. Baseline features associated with low T3 syndrome were analyzed and balanced by propensity score matching. Univariate and multivariate regression analyses were performed to determine independent risk factors for progression-free survival (PFS) and overall survival (OS). A receiver operating characteristic (ROC) curve was plotted, and the area under the curve (AUC) was calculated to assess the predictive accuracy of FL international prognostic index FLIPI-1/FLIPI-2 and low T3 syndrome. A total of 22 patients (10.0%) had low T3 syndrome at diagnosis, which was associated with poor PFS and OS in the rituximab era. It is an independent prognostic factor for PFS and OS. Low T3 syndrome and FLIPI-1/FLIPI-2 significantly increased the AUC of PFS and OS compared to FLIPI-1/FLIPI-2 alone. Low T3 is a risk factor for POD24. In conclusion, low T3 syndrome may be a good candidate for predicting the prognosis of CLL in future clinical practice. Our study demonstrates that low T3 syndrome is associated with poorer survival outcomes in FL patients.

Associations between serum polychlorinated biphenyls, halogen flame retardants, and renal function indexes in residents of an e-waste recycling area

E-waste handling activities release large quantities of polychlorinated biphenyls (PCBs) and halogen flame retardants (HFRs) into the surrounding area, creating a high exposure risk for local residents. However, the possibility of PCBs and HFRs exposure contributing to renal injury has not been extensively studied. To fill this knowledge gap, we conducted an epidemiological analysis of adolescents and adults recruited from an e-waste recycling area and a control area. Some PCBs and HFRs compounds were statistically significantly associated with the levels of β₂-microglobulin (β₂-MG), blood urea nitrogen (BUN), serum creatinine (SCr), and uric acid, with thyroid hormone-related genes found to partly mediate these associations. The interactions of PCBs and HFRs with metals also influenced renal function indexes. Exposure to high concentrations of PCBs and HFRs resulted in higher levels of β₂-MG and lower levels of BUN and SCr in the exposed group. As indicated by the elevated β₂-MG levels, high exposure to PCBs and HFRs may increase the risk of early renal injury for adolescents. These findings help to clarify the impacts of PCBs and HFRs on renal function and highlight the need to protect the health of residents in regions impacted by e-waste handling activities.

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

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.