Association of thyroid functional disease with mortality in a national cohort of incident hemodialysis patients

Connie M. Rhee, 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

Research output: Contribution to journalArticle

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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, weexamined 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, weexamined 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.

Original languageEnglish (US)
Pages (from-to)1386-1395
Number of pages10
JournalJournal of Clinical Endocrinology and Metabolism
Volume100
Issue number4
DOIs
StatePublished - Apr 1 2015

Fingerprint

Thyroid Diseases
Hypothyroidism
Renal Dialysis
Mortality
Dialysis
Thyroid Hormones
Restoration
Hazards
Population
Diagnosis-Related Groups
Hormone Replacement Therapy
Proportional Hazards Models
Patient Care
Reference Values
Body Mass Index
Outcome Assessment (Health Care)
Confidence Intervals
Survival

ASJC Scopus subject areas

  • Biochemistry
  • Clinical Biochemistry
  • Endocrinology
  • Biochemistry, medical
  • Endocrinology, Diabetes and Metabolism

Cite this

Association of thyroid functional disease with mortality in a national cohort of incident hemodialysis patients. / Rhee, Connie M.; Kim, Steven; Gillen, Daniel L.; Oztan, Tolga; Wang, Jiaxi; Mehrotra, Rajnish; Kuttykrishnan, Sooraj; Nguyen, Danh V.; Brunelli, Steven M.; Kovesdy, Csaba P.; Brent, Gregory A.; Kalantar-Zadeh, Kamyar.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 100, No. 4, 01.04.2015, p. 1386-1395.

Research output: Contribution to journalArticle

Rhee, CM, Kim, S, Gillen, DL, Oztan, T, Wang, J, Mehrotra, R, Kuttykrishnan, S, Nguyen, DV, Brunelli, SM, Kovesdy, CP, Brent, GA & Kalantar-Zadeh, K 2015, 'Association of thyroid functional disease with mortality in a national cohort of incident hemodialysis patients', Journal of Clinical Endocrinology and Metabolism, vol. 100, no. 4, pp. 1386-1395. https://doi.org/10.1210/jc.2014-4311
Rhee, Connie M. ; Kim, Steven ; Gillen, Daniel L. ; Oztan, Tolga ; Wang, Jiaxi ; Mehrotra, Rajnish ; Kuttykrishnan, Sooraj ; Nguyen, Danh V. ; Brunelli, Steven M. ; Kovesdy, Csaba P. ; Brent, Gregory A. ; Kalantar-Zadeh, Kamyar. / Association of thyroid functional disease with mortality in a national cohort of incident hemodialysis patients. In: Journal of Clinical Endocrinology and Metabolism. 2015 ; Vol. 100, No. 4. pp. 1386-1395.
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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, weexamined 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, weexamined 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.",
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AU - Rhee, Connie M.

AU - Kim, Steven

AU - Gillen, Daniel L.

AU - Oztan, Tolga

AU - Wang, Jiaxi

AU - Mehrotra, Rajnish

AU - Kuttykrishnan, Sooraj

AU - Nguyen, Danh V.

AU - Brunelli, Steven M.

AU - Kovesdy, Csaba P.

AU - Brent, Gregory A.

AU - Kalantar-Zadeh, Kamyar

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N2 - 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, weexamined 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, weexamined 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.

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