Connie M Rhee1, Kamyar Kalantar-Zadeh1, Elani Streja1, Juan-Jesus Carrero2, Jennie Z Ma3, Jun L Lu4, Csaba P Kovesdy5. 1. Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, CA, USA. 2. Division of Nephrology, Karolinska Institutet, Stockholm, Sweden. 3. Division of Nephrology, University of Virginia, Charlottesville, VA, USA. 4. Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA. 5. Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA Division of Nephrology, Memphis Veterans Affairs Medical Center, Memphis, TN, USA.
Abstract
BACKGROUND: Recent studies have shown an increasing risk of hypothyroidism with incrementally lower estimated glomerular filtration rate (eGFR) in cohorts comprised of patients with normal to mildly impaired kidney function. We sought to confirm these findings in a nationally representative cohort of Veterans Affairs patients with moderate-to-severe chronic kidney disease (CKD). METHODS: This study examined the association between kidney function and hypothyroidism among 461 607 veterans with Stage 3 to 5 CKD who underwent repeated measurements of serum creatinine and thyrotropin (TSH) at identical time points between October 2004 and September 2006. Kidney function was defined by eGFR using the Chronic Kidney Disease Epidemiology Collaboration formula. In primary analyses, the association between eGFR and hypothyroidism (defined as serum TSH > 5 mIU/L and/or receipt of thyroid hormone supplementation) was estimated using multivariable random effects logistic regression. In secondary analyses, the association between eGFR and serum TSH level was estimated using multivariable random effects linear regression. RESULTS: At baseline, 68.9, 25.5, 5.3 and 0.3% of patients had Stage 3A, 3B, 4 and 5 CKD, respectively. For every 10 mL/min/1.73 m(2) lower eGFR, there was an 18% higher risk of hypothyroidism: adjusted odds ratio 1.18 [95% confidence interval (CI) 1.17-1.20, P < 0.001]. In secondary analyses, we observed that a 10 mL/min/1.73 m(2) lower eGFR was associated with a 0.11 mIU/L higher serum TSH (95% CI 0.10-0.11 mIU/L higher serum TSH, P < 0.001). CONCLUSIONS: In a nationally representative cohort of patients with moderate-to-severe CKD, there is an inverse association between eGFR and risk of hypothyroidism.
BACKGROUND: Recent studies have shown an increasing risk of hypothyroidism with incrementally lower estimated glomerular filtration rate (eGFR) in cohorts comprised of patients with normal to mildly impaired kidney function. We sought to confirm these findings in a nationally representative cohort of Veterans Affairs patients with moderate-to-severe chronic kidney disease (CKD). METHODS: This study examined the association between kidney function and hypothyroidism among 461 607 veterans with Stage 3 to 5 CKD who underwent repeated measurements of serum creatinine and thyrotropin (TSH) at identical time points between October 2004 and September 2006. Kidney function was defined by eGFR using the Chronic Kidney Disease Epidemiology Collaboration formula. In primary analyses, the association between eGFR and hypothyroidism (defined as serum TSH > 5 mIU/L and/or receipt of thyroid hormone supplementation) was estimated using multivariable random effects logistic regression. In secondary analyses, the association between eGFR and serum TSH level was estimated using multivariable random effects linear regression. RESULTS: At baseline, 68.9, 25.5, 5.3 and 0.3% of patients had Stage 3A, 3B, 4 and 5 CKD, respectively. For every 10 mL/min/1.73 m(2) lower eGFR, there was an 18% higher risk of hypothyroidism: adjusted odds ratio 1.18 [95% confidence interval (CI) 1.17-1.20, P < 0.001]. In secondary analyses, we observed that a 10 mL/min/1.73 m(2) lower eGFR was associated with a 0.11 mIU/L higher serum TSH (95% CI 0.10-0.11 mIU/L higher serum TSH, P < 0.001). CONCLUSIONS: In a nationally representative cohort of patients with moderate-to-severe CKD, there is an inverse association between eGFR and risk of hypothyroidism.
Authors: Zubair Baloch; Pierre Carayon; Bernard Conte-Devolx; Laurence M Demers; Ulla Feldt-Rasmussen; Jean-François Henry; Virginia A LiVosli; Patricia Niccoli-Sire; Rhys John; Jean Ruf; Peter P A Smyth; Carole A Spencer; Jan R Stockigt Journal: Thyroid Date: 2003-01 Impact factor: 6.568
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: Csaba P Kovesdy; Anthony J Bleyer; Miklos Z Molnar; Jennie Z Ma; John J Sim; William C Cushman; L Darryl Quarles; Kamyar Kalantar-Zadeh Journal: Ann Intern Med Date: 2013-08-20 Impact factor: 25.391
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: Andrew S Levey; Lesley A Stevens; Christopher H Schmid; Yaping Lucy Zhang; Alejandro F Castro; Harold I Feldman; John W Kusek; Paul Eggers; Frederick Van Lente; Tom Greene; Josef Coresh Journal: Ann Intern Med Date: 2009-05-05 Impact factor: 25.391
Authors: Connie M Rhee; Yanjun Chen; Amy S You; Steven M Brunelli; Csaba P Kovesdy; Matthew J Budoff; Gregory A Brent; Kamyar Kalantar-Zadeh; Danh V Nguyen Journal: Clin J Am Soc Nephrol Date: 2017-07-13 Impact factor: 8.237
Authors: Érique José F Peixoto de Miranda; Márcio Sommer Bittencourt; Alessandra C Goulart; Itamar S Santos; Silvia Maria de Oliveira Titan; Roberto Marini Ladeira; Sandhi Maria Barreto; Paulo A Lotufo; Isabela Judith Martins Benseñor Journal: Clin Exp Nephrol Date: 2017-03-27 Impact factor: 2.801
Authors: Connie M Rhee; Kamyar Kalantar-Zadeh; Vanessa Ravel; Elani Streja; Amy S You; Steven M Brunelli; Danh V Nguyen; Gregory A Brent; Csaba P Kovesdy Journal: Mayo Clin Proc Date: 2018-05 Impact factor: 7.616
Authors: Christiaan L Meuwese; Merel van Diepen; Anne R Cappola; Mark J Sarnak; Michael G Shlipak; Douglas C Bauer; Linda P Fried; Massimo Iacoviello; Bert Vaes; Jean Degryse; Kay-Tee Khaw; Robert N Luben; Bjørn O Åsvold; Trine Bjøro; Lars J Vatten; Anton J M de Craen; Stella Trompet; Giorgio Iervasi; Sabrina Molinaro; Graziano Ceresini; Luigi Ferrucci; Robin P F Dullaart; Stephan J L Bakker; J Wouter Jukema; Patricia M Kearney; David J Stott; Robin P Peeters; Oscar H Franco; Henry Völzke; John P Walsh; Alexandra Bremner; José A Sgarbi; Rui M B Maciel; Misa Imaizumi; Waka Ohishi; Friedo W Dekker; Nicolas Rodondi; Jacobijn Gussekloo; Wendy P J den Elzen Journal: Nephrol Dial Transplant Date: 2019-04-01 Impact factor: 5.992
Authors: Connie M Rhee; Amy S You; Danh V Nguyen; Steven M Brunelli; Matthew J Budoff; Elani Streja; Tracy Nakata; Csaba P Kovesdy; Gregory A Brent; Kamyar Kalantar-Zadeh Journal: J Clin Endocrinol Metab Date: 2017-05-01 Impact factor: 5.958