Connie M Rhee1, 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. 1. Harold Simmons Center for Chronic Disease Research and Epidemiology (C.M.R., K.K.-Z.), Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, California 92868; Los Angeles Biomedical Research Institute (C.M.R., K.K.-Z.), Harbor-UCLA Medical Center Torrance, California 90502; Department of Statistics (S.K., D.L.G., T.O., J.W.), University of California Irvine School of Medicine, Irvine, California 92697; Division of Nephrology (R.M., S.K.), Harborview Medical Center, University of Washington, Seattle, Washington 98104; Division of General Internal Medicine (D.V.N.), University of California Irvine Medical Center, Orange, California 92868; DaVita Clinical Research (S.M.B.), Minneapolis, Minnesota 55404; Nephrology Section (C.P.K.), Memphis Veterans Affairs Medical Center, Memphis, Tennessee 38104; Division of Nephrology (C.P.K.), University of Tennessee Health Science Center, Memphis, Tennessee 38163; and Division of Endocrinology (G.A.B.), University of California Los Angeles, Los Angeles, California 90095.
Abstract
CONTEXT: Hypothyroidism is a common condition that disproportionately affects hemodialysis patients. In the general population, hypothyroidism is associated with higher mortality, particularly in populations with underlying cardiovascular risk. Despite their heightened cardiovascular mortality, the impact of hypothyroidism on the survival of hemodialysis patients remains uncertain. OBJECTIVE: To examine whether hypothyroidism is independently associated with higher mortality in hemodialysis patients. DESIGN, SETTING, AND PATIENTS: Among 8840 incident hemodialysis patients receiving care from a large national dialysis provider from January 2007 to December 2011, we examined the association of hypothyroidism (TSH >5.0 mIU/L) with mortality. MAIN OUTCOME MEASURES: Associations between baseline and time-dependent hypothyroidism with all-cause mortality were determined using case-mix adjusted Cox models. In secondary analyses, we examined the impact of low-normal, upper-normal, subclinical range, and overt range TSH levels (TSH ≥ 0.5-3.0, >3.0-5.0, >5.0-10.0, and >10.0 mIU/L, respectively) on mortality risk. RESULTS: The study population consisted of 1928 (22%) hypothyroid and 6912 (78%) euthyroid patients. Baseline and time-dependent hypothyroidism were associated with higher mortality: adjusted hazard ratios (95% confidence intervals) were 1.47 (1.34-1.61) and 1.62 (1.45-1.80), respectively. Compared to low-normal TSH, upper-normal, subclinical hypothyroid, and overt hypothyroid TSH levels were associated with incrementally higher adjusted death risk in baseline and time-dependent analyses. In time-dependent analyses, the hypothyroidism-mortality association was increasingly stronger across higher body mass index strata. CONCLUSIONS: Hypothyroidism as well as upper-normal TSH levels are associated with higher mortality in hemodialysis patients. Further studies are needed to determine whether restoration of TSH to low-normal levels with thyroid hormone replacement therapy ameliorates adverse outcomes in hemodialysis patients.
CONTEXT: Hypothyroidism is a common condition that disproportionately affects hemodialysis patients. In the general population, hypothyroidism is associated with higher mortality, particularly in populations with underlying cardiovascular risk. Despite their heightened cardiovascular mortality, the impact of hypothyroidism on the survival of hemodialysis patients remains uncertain. OBJECTIVE: To examine whether hypothyroidism is independently associated with higher mortality in hemodialysis patients. DESIGN, SETTING, AND PATIENTS: Among 8840 incident hemodialysis patients receiving care from a large national dialysis provider from January 2007 to December 2011, we examined the association of hypothyroidism (TSH >5.0 mIU/L) with mortality. MAIN OUTCOME MEASURES: Associations between baseline and time-dependent hypothyroidism with all-cause mortality were determined using case-mix adjusted Cox models. In secondary analyses, we examined the impact of low-normal, upper-normal, subclinical range, and overt range TSH levels (TSH ≥ 0.5-3.0, >3.0-5.0, >5.0-10.0, and >10.0 mIU/L, respectively) on mortality risk. RESULTS: The study population consisted of 1928 (22%) hypothyroid and 6912 (78%) euthyroid patients. Baseline and time-dependent hypothyroidism were associated with higher mortality: adjusted hazard ratios (95% confidence intervals) were 1.47 (1.34-1.61) and 1.62 (1.45-1.80), respectively. Compared to low-normal TSH, upper-normal, subclinical hypothyroid, and overt hypothyroidTSH levels were associated with incrementally higher adjusted death risk in baseline and time-dependent analyses. In time-dependent analyses, the hypothyroidism-mortality association was increasingly stronger across higher body mass index strata. CONCLUSIONS:Hypothyroidism as well as upper-normal TSH levels are associated with higher mortality in hemodialysis patients. Further studies are needed to determine whether restoration of TSH to low-normal levels with thyroid hormone replacement therapy ameliorates adverse outcomes in hemodialysis patients.
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: Christiaan L Meuwese; Friedo W Dekker; Bengt Lindholm; Abdul R Qureshi; Olof Heimburger; Peter Barany; Peter Stenvinkel; Juan J Carrero Journal: Clin J Am Soc Nephrol Date: 2012-01 Impact factor: 8.237
Authors: Christiane Drechsler; Andreas Schneider; Lena Gutjahr-Lengsfeld; Matthias Kroiss; Juan Jesús Carrero; Vera Krane; Bruno Allolio; Christoph Wanner; Martin Fassnacht Journal: Am J Kidney Dis Date: 2013-12-04 Impact factor: 8.860
Authors: Christiaan L Meuwese; Juan J Carrero; Iván Cabezas-Rodríguez; Olof Heimburger; Peter Barany; Bengt Lindholm; Abdul R Qureshi; Jonaz Ripsweden; Friedo W Dekker; Peter Stenvinkel Journal: J Intern Med Date: 2013-07-15 Impact factor: 8.989
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: 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: 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
Authors: Jerry Yu; Vanessa A Ravel; Amy S You; Elani Streja; Matthew B Rivara; Praveen K Potukuchi; Steven M Brunelli; Csaba P Kovesdy; Kamyar Kalantar-Zadeh; Connie M Rhee Journal: Am J Nephrol Date: 2017-09-01 Impact factor: 3.754