OBJECTIVES: Low triiodothyronine levels, as part of the nonthyroidal illness syndrome, are common in dialysis patients and have repeatedly been shown to be associated with increased (cardiovascular) mortality rates. We hypothesized that increased vascular calcification may mediate this relationship. METHODS: A total of 84 patients from the Stockholm region receiving maintenance peritoneal dialysis were included in the study. Serum concentrations of free triiodothyronine (fT3), thyroxine and thyroid-stimulating hormone were measured. Coronary artery calcium (CAC) scores were assessed by cardiac computed tomography scans. Surrogates of arterial stiffness included aortic diastolic and systolic blood pressures, pulse pressure, augmentation pressure and Buckberg's subendocardial viability ratio measured by pulse waveform analyses. Patients were subsequently followed, and events of death and censoring were recorded. Thyroid hormone concentrations were associated with CAC scores, measures of arterial stiffness and all-cause mortality. The associations between CAC scores and arterial stiffness surrogates and mortality were also determined to evaluate a possible causal pathway. RESULTS: Both CAC scores and arterial stiffness surrogates were substantially higher in individuals with low fT3 levels. These associations persisted in multivariate logistic and linear regression analyses. During a median (interquartile range) follow-up of 32 (22-42) months, 24 patients died. Both fT3 levels below the median value [HR crude 4.1, 95% confidence interval (CI) 1.4-12.6] and CAC scores above the median value (HR crude 5.8, 95% CI 1.7-20.1) were strongly associated with mortality. CONCLUSIONS: In patients undergoing peritoneal dialysis, fT3 levels were strongly associated with arterial stiffness, coronary artery calcification and mortality. We speculate that the association between nonthyroidal illness and mortality may be partly mediated by acceleration of vascular calcification.
OBJECTIVES: Low triiodothyronine levels, as part of the nonthyroidal illness syndrome, are common in dialysis patients and have repeatedly been shown to be associated with increased (cardiovascular) mortality rates. We hypothesized that increased vascular calcification may mediate this relationship. METHODS: A total of 84 patients from the Stockholm region receiving maintenance peritoneal dialysis were included in the study. Serum concentrations of free triiodothyronine (fT3), thyroxine and thyroid-stimulating hormone were measured. Coronary artery calcium (CAC) scores were assessed by cardiac computed tomography scans. Surrogates of arterial stiffness included aortic diastolic and systolic blood pressures, pulse pressure, augmentation pressure and Buckberg's subendocardial viability ratio measured by pulse waveform analyses. Patients were subsequently followed, and events of death and censoring were recorded. Thyroid hormone concentrations were associated with CAC scores, measures of arterial stiffness and all-cause mortality. The associations between CAC scores and arterial stiffness surrogates and mortality were also determined to evaluate a possible causal pathway. RESULTS: Both CAC scores and arterial stiffness surrogates were substantially higher in individuals with low fT3 levels. These associations persisted in multivariate logistic and linear regression analyses. During a median (interquartile range) follow-up of 32 (22-42) months, 24 patients died. Both fT3 levels below the median value [HR crude 4.1, 95% confidence interval (CI) 1.4-12.6] and CAC scores above the median value (HR crude 5.8, 95% CI 1.7-20.1) were strongly associated with mortality. CONCLUSIONS: In patients undergoing peritoneal dialysis, fT3 levels were strongly associated with arterial stiffness, coronary artery calcification and mortality. We speculate that the association between nonthyroidal illness and mortality may be partly mediated by acceleration of vascular calcification.
Authors: Christiaan L Meuwese; Olaf M Dekkers; Peter Stenvinkel; Friedo W Dekker; Juan J Carrero Journal: Nat Rev Nephrol Date: 2013-09-03 Impact factor: 28.314
Authors: Connie M Rhee; Steven Kim; Daniel L Gillen; Tolga Oztan; Jiaxi Wang; Rajnish Mehrotra; Sooraj Kuttykrishnan; Danh V Nguyen; Steven M Brunelli; Csaba P Kovesdy; Gregory A Brent; Kamyar Kalantar-Zadeh Journal: J Clin Endocrinol Metab Date: 2015-01-29 Impact factor: 5.958
Authors: Connie M Rhee; Matthew Budoff; Gregory Brent; Amy S You; Peter Stenvinkel; Alejandra Novoa; Ferdinand Flores; Sajad Hamal; Christopher Dailing; April Kinninger; Tracy Nakata; Csaba P Kovesdy; Danh V Nguyen; Kamyar Kalantar-Zadeh Journal: Cardiorenal Med Date: 2022-05-12 Impact factor: 4.360
Authors: Connie M Rhee; Gregory A Brent; Csaba P Kovesdy; Offie P Soldin; Danh Nguyen; Matthew J Budoff; Steven M Brunelli; Kamyar Kalantar-Zadeh Journal: Nephrol Dial Transplant Date: 2014-02-25 Impact factor: 5.992
Authors: Christiaan Lucas Meuwese; Hannes Olauson; Abdul Rashid Qureshi; Jonaz Ripsweden; Peter Barany; Cees Vermeer; Nadja Drummen; Peter Stenvinkel Journal: PLoS One Date: 2015-07-06 Impact factor: 3.240