Hong Xu1, Nele Brusselaers2, Bengt Lindholm1, Carmine Zoccali3, Juan Jesús Carrero4. 1. Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Division of Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden. 2. Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. 3. Division of Nephrology, Dialysis and Kidney Transplantation, CNR Hospital, Reggio Calabria, Italy. 4. Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Division of Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. Electronic address: juan.jesus.carrero@ki.se.
Abstract
BACKGROUND: We evaluated current evidence associating thyroid function test result derangements with risk for mortality in patients with chronic kidney failure treated by long-term dialysis. STUDY DESIGN: Systematic review and meta-analysis of cohort studies. SETTING & POPULATION: Dialysis patients. SELECTION CRITERIA FOR STUDIES: We searched PubMed, Web of Science, Science Citation Index, Cochrane Library, and Embase databases from inception through December 2015. PREDICTORS: Hypothyroidism (thyrotropin level greater than reference range) and low triiodothyronine (T3) and thyroxine (T4) levels. OUTCOMES: All-cause and cardiovascular mortality. RESULTS: 12 studies involving 14,766 participants (4,450 deaths) were identified. Of those, 6 studies provided data for cardiovascular mortality (2,772 participants with 327 cardiovascular deaths). Overall, confidence in the available evidence was moderate. Pooled adjusted HRs for all-cause mortality associated with hypothyroidism, low T3 level, and low T4 level were 1.24 (95% CI, 1.14-1.34), 1.67 (95% CI, 1.23-2.27), and 2.40 (95% CI, 1.47-3.93), respectively. Pooled adjusted HRs for cardiovascular mortality associated with low T3 and T4 levels were 1.84 (95% CI, 1.24-2.74) and 3.06 (95% CI, 1.29-7.24), respectively. LIMITATIONS: Fewer studies reporting on T4 and thyrotropin outcomes. CONCLUSIONS: In patients treated with long-term dialysis, (cardiovascular) mortality is consistently higher in the presence of thyroid function test result derangements.
BACKGROUND: We evaluated current evidence associating thyroid function test result derangements with risk for mortality in patients with chronic kidney failure treated by long-term dialysis. STUDY DESIGN: Systematic review and meta-analysis of cohort studies. SETTING & POPULATION: Dialysis patients. SELECTION CRITERIA FOR STUDIES: We searched PubMed, Web of Science, Science Citation Index, Cochrane Library, and Embase databases from inception through December 2015. PREDICTORS: Hypothyroidism (thyrotropin level greater than reference range) and low triiodothyronine (T3) and thyroxine (T4) levels. OUTCOMES: All-cause and cardiovascular mortality. RESULTS: 12 studies involving 14,766 participants (4,450 deaths) were identified. Of those, 6 studies provided data for cardiovascular mortality (2,772 participants with 327 cardiovascular deaths). Overall, confidence in the available evidence was moderate. Pooled adjusted HRs for all-cause mortality associated with hypothyroidism, low T3 level, and low T4 level were 1.24 (95% CI, 1.14-1.34), 1.67 (95% CI, 1.23-2.27), and 2.40 (95% CI, 1.47-3.93), respectively. Pooled adjusted HRs for cardiovascular mortality associated with low T3 and T4 levels were 1.84 (95% CI, 1.24-2.74) and 3.06 (95% CI, 1.29-7.24), respectively. LIMITATIONS: Fewer studies reporting on T4 and thyrotropin outcomes. CONCLUSIONS: In patients treated with long-term dialysis, (cardiovascular) mortality is consistently higher in the presence of thyroid function test result derangements.
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