Baris Afsar1, Mahmut Ilker Yilmaz2, Dimitrie Siriopol3, Hilmi Umut Unal2, Mutlu Saglam4, Murat Karaman2, Mustafa Gezer2, Alper Sonmez5, Tayfun Eyileten2, Ibrahim Aydin5, Salih Hamcan6, Yusuf Oguz2, Adrian Covic3, Mehmet Kanbay7,8. 1. Department of Nephrology, Konya Numune State Hospital, Konya, Turkey. 2. Department of Nephrology, Gulhane School of Medicine, Ankara, Turkey. 3. Nephrology Clinic, Dialysis and Renal Transplant Center, 'C.I. PARHON' University Hospital, 'Grigore T. Popa' University of Medicine, Iasi, Romania. 4. Department of Radiology, Gulhane School of Medicine, Ankara, Turkey. 5. Department of Endocrinology, Gulhane School of Medicine, Ankara, Turkey. 6. Department of Biochemistry, Gulhane School of Medicine, Ankara, Turkey. 7. Department of Nephrology, Gulhane School of Medicine, Ankara, Turkey. drkanbay@yahoo.com. 8. Department of Medicine, Division of Nephrology, Koc University School of Medicine, Topkapı, 03490, Istanbul, Turkey. drkanbay@yahoo.com.
Abstract
BACKGROUND AND AIMS: Abnormalities of thyroid function are commonly seen in chronic kidney disease (CKD) patients. They are associated with adverse clinical conditions such as atherosclerosis, endothelial dysfunction, inflammation and abnormal blood pressure variability. We investigated the association between thyroid disorders and endothelial function, assessed by flow-mediated dilatation (FMD) and carotid intima-media thickness (CIMT), and cardiovascular events (CVE) in CKD patients. MATERIALS AND METHODS: This observational cohort study included 305 CKD (stages 1-5) patients. Routine biochemistry, including free T3, free T4 and thyroid stimulating hormone, fibroblast growth factor-23 (FGF-23) and FMD, CIMT were measured. We divided patients into four groups according to thyroid hormone status: euthyroidism, subclinical hyperthyroidism, subclinical hypothyroidism, and euthyroid sick syndrome. Fatal and composite CVE were recorded for a median 29 months. RESULTS: Patients with subclinical hypothyroidism had a higher prevalence of hypertension and diabetes and also were more likely to have higher values of systolic CIMT, phosphorus, intact parathormone (iPTH), FGF-23, homeostasis model assessment-insulin resistance and lower levels of FMD than euthyroid patients. In the unadjusted survival analysis, subclinical hypothyroidism and euthyroid sick syndrome were associated with an increased risk for the outcome as compared with euthyroidism [hazard ratio 30.63 (95 % confidence interval 12.27-76.48) and 12.17 (3.70-39.98), respectively]. The effects of subclinical hypothyroidism and euthyroid sick syndrome were maintained even in fully adjusted models. CONCLUSION: We demonstrated that subclinical hypothyroidism and euthyroid sick syndrome are associated with increased CVE in CKD patients. Further studies are needed to explore these issues.
BACKGROUND AND AIMS: Abnormalities of thyroid function are commonly seen in chronic kidney disease (CKD) patients. They are associated with adverse clinical conditions such as atherosclerosis, endothelial dysfunction, inflammation and abnormal blood pressure variability. We investigated the association between thyroid disorders and endothelial function, assessed by flow-mediated dilatation (FMD) and carotid intima-media thickness (CIMT), and cardiovascular events (CVE) in CKDpatients. MATERIALS AND METHODS: This observational cohort study included 305 CKD (stages 1-5) patients. Routine biochemistry, including free T3, free T4 and thyroid stimulating hormone, fibroblast growth factor-23 (FGF-23) and FMD, CIMT were measured. We divided patients into four groups according to thyroid hormone status: euthyroidism, subclinical hyperthyroidism, subclinical hypothyroidism, and euthyroid sick syndrome. Fatal and composite CVE were recorded for a median 29 months. RESULTS:Patients with subclinical hypothyroidism had a higher prevalence of hypertension and diabetes and also were more likely to have higher values of systolic CIMT, phosphorus, intact parathormone (iPTH), FGF-23, homeostasis model assessment-insulin resistance and lower levels of FMD than euthyroid patients. In the unadjusted survival analysis, subclinical hypothyroidism and euthyroid sick syndrome were associated with an increased risk for the outcome as compared with euthyroidism [hazard ratio 30.63 (95 % confidence interval 12.27-76.48) and 12.17 (3.70-39.98), respectively]. The effects of subclinical hypothyroidism and euthyroid sick syndrome were maintained even in fully adjusted models. CONCLUSION: We demonstrated that subclinical hypothyroidism and euthyroid sick syndrome are associated with increased CVE in CKDpatients. Further studies are needed to explore these issues.
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: D S Celermajer; K E Sorensen; V M Gooch; D J Spiegelhalter; O I Miller; I D Sullivan; J K Lloyd; J E Deanfield Journal: Lancet Date: 1992-11-07 Impact factor: 79.321
Authors: L E Zijlstra; D M van Velzen; S Simsek; S P Mooijaart; M van Buren; D J Stott; I Ford; J W Jukema; S Trompet Journal: Endocr Connect Date: 2020-01 Impact factor: 3.335