Connie M Rhee1, Matthew Budoff2, Gregory Brent3,4, Amy S You1, Peter Stenvinkel5, Alejandra Novoa1, Ferdinand Flores2, Sajad Hamal2, Christopher Dailing2, April Kinninger2, Tracy Nakata1, Csaba P Kovesdy6,7, Danh V Nguyen8, Kamyar Kalantar-Zadeh1,9. 1. Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, California, USA. 2. Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, California, USA. 3. Division of Endocrinology, Diabetes and Metabolism, David Geffen School of Medicine at UCLA, Los Angeles, California, USA. 4. Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA. 5. Department of Renal Medicine M99, Karolinska Institutet, Stockholm, Sweden. 6. Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee, USA. 7. Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, Tennessee, USA. 8. Division of General Internal Medicine, University of California Irvine School of Medicine, Orange, California, USA. 9. Tibor Rubin Veterans Affairs Medical Center, Long Beach, California, USA.
Abstract
INTRODUCTION: Hypothyroidism is highly prevalent in end-stage kidney disease patients, and emerging data show that lower circulating thyroid hormone levels lead to downregulation of vascular calcification inhibitors and coronary artery calcification (CAC) in this population. To date, no studies have examined the association of serum thyrotropin (TSH), the most sensitive and specific single biochemical metric of thyroid function, with CAC risk in hemodialysis patients. METHODS: In secondary analyses of patients from the Anti-Inflammatory and Anti-Oxidative Nutrition in Hypoalbuminemic Dialysis Patients trial, we examined serum TSH levels and CAC risk assessed by cardiac computed tomography scans collected within a 90-day period. We evaluated the relationship between serum TSH with CAC Volume (VS) and Agatston score (AS) (defined as >100 mm3 and >100 Houndsfield Units, respectively) using multivariable logistic regression. RESULTS: Among 104 patients who met eligibility criteria, higher TSH levels in the highest tertile were associated with moderately elevated CAC VS and AS in case-mix-adjusted analyses (ref: lowest tertile): adjusted ORs (95% CIs) 4.26 (1.18, 15.40) and 5.53 (1.44, 21.30), respectively. TSH levels >3.0 mIU/L (ref: ≤3.0 mIU/L) were also associated with moderately elevated CAC VS and AS. In secondary analyses, point estimates of incrementally lower direct free thyroxine levels trended toward elevated CAC VS and AS, although associations did not achieve statistical significance. CONCLUSIONS: In hemodialysis patients, higher serum TSH was associated with elevated CAC VS and AS. Further studies are needed to determine if thyroid hormone supplementation can attenuate CAC burden in this population.
INTRODUCTION: Hypothyroidism is highly prevalent in end-stage kidney disease patients, and emerging data show that lower circulating thyroid hormone levels lead to downregulation of vascular calcification inhibitors and coronary artery calcification (CAC) in this population. To date, no studies have examined the association of serum thyrotropin (TSH), the most sensitive and specific single biochemical metric of thyroid function, with CAC risk in hemodialysis patients. METHODS: In secondary analyses of patients from the Anti-Inflammatory and Anti-Oxidative Nutrition in Hypoalbuminemic Dialysis Patients trial, we examined serum TSH levels and CAC risk assessed by cardiac computed tomography scans collected within a 90-day period. We evaluated the relationship between serum TSH with CAC Volume (VS) and Agatston score (AS) (defined as >100 mm3 and >100 Houndsfield Units, respectively) using multivariable logistic regression. RESULTS: Among 104 patients who met eligibility criteria, higher TSH levels in the highest tertile were associated with moderately elevated CAC VS and AS in case-mix-adjusted analyses (ref: lowest tertile): adjusted ORs (95% CIs) 4.26 (1.18, 15.40) and 5.53 (1.44, 21.30), respectively. TSH levels >3.0 mIU/L (ref: ≤3.0 mIU/L) were also associated with moderately elevated CAC VS and AS. In secondary analyses, point estimates of incrementally lower direct free thyroxine levels trended toward elevated CAC VS and AS, although associations did not achieve statistical significance. CONCLUSIONS: In hemodialysis patients, higher serum TSH was associated with elevated CAC VS and AS. Further studies are needed to determine if thyroid hormone supplementation can attenuate CAC burden in this population.
Authors: Nicolas Rodondi; Wendy P J den Elzen; Douglas C Bauer; Anne R Cappola; Salman Razvi; John P Walsh; Bjørn O Asvold; Giorgio Iervasi; Misa Imaizumi; Tinh-Hai Collet; Alexandra Bremner; Patrick Maisonneuve; José A Sgarbi; Kay-Tee Khaw; Mark P J Vanderpump; Anne B Newman; Jacques Cornuz; Jayne A Franklyn; Rudi G J Westendorp; Eric Vittinghoff; Jacobijn Gussekloo Journal: JAMA Date: 2010-09-22 Impact factor: 56.272
Authors: Tiziano Schepis; Oliver Gaemperli; Pascal Koepfli; Mehdi Namdar; Ines Valenta; Hans Scheffel; Sebastian Leschka; Lars Husmann; Franz R Eberli; Thomas F Luscher; Hatem Alkadhi; Philipp A Kaufmann Journal: J Nucl Med Date: 2007-09 Impact factor: 10.057