Thyroid status and mortality in a prospective hemodialysis cohort

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

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Context and Objective: Compared with the general population, hemodialysis patients have a substantially higher risk of hypothyroidism, as defined by an elevated serum thyrotropin (TSH) level, and cardiovascularmortality.Whereas an elevated TSHis associated with cardiovascular disease and death in the general population, associations among dialysis patients have been inconsistent. Design, Setting, Participants, and Main Outcome: We examined 541 hemodialysis patients from 17 southern California dialysis centers in the prospective Hypothyroidism, Cardiovascular Health, and Survival study who underwent protocolized measurement of repeated serum TSH levels every 6 months from 2013 to 2015. Associations between TSH tertiles (,1.28, 1.28 to ,2.14, and 2.14 to 86.7 mIU/L) and mortality were estimated using time-dependent Cox models with four adjustment levels. In sensitivity analyses, we excluded patients receiving thyroid hormone supplementation. Results: Compared with the lowest TSH tertile, the highest TSH tertile was associated with a 2.2-to 2.5-fold higher mortality risk in unadjusted, case-mix, expanded case-mix1laboratory, and expanded case-mix1laboratory1medication models [hazard ratios (95% confidence interval), 2.54 (1.32 to 4.89), 2.53 (1.30 to 4.93), 2.19 (1.11 to 4.32), and 2.28 (1.45 to 3.58), respectively]. We observed a consistent trend between higher TSH tertiles and numerically higher mortality risk across all models. Similar findings were observed in analyses excluding patients receiving thyroid hormone supplementation. Conclusion: In time-dependent analyses, TSH levels in the high-normal to high range were independently associated with higher death risk in hemodialysis patients. Further studies are indicated to determine whether normalization of TSH levels with thyroid hormone supplementation improves survival in this population. (J Clin Endocrinol Metab 102: 1568-1577, 2017).

Original languageEnglish (US)
Pages (from-to)1568-1577
Number of pages10
JournalJournal of Clinical Endocrinology and Metabolism
Volume102
Issue number5
DOIs
StatePublished - May 1 2017

Fingerprint

Renal Dialysis
Thyroid Gland
Thyroid Hormones
Dialysis
Mortality
Hypothyroidism
Proportional Hazards Models
Thyrotropin
Population
Hazards
Survival
Diagnosis-Related Groups
Health
Serum
Cardiovascular Diseases
Confidence Intervals

ASJC Scopus subject areas

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

Cite this

Rhee, C. M., You, A. S., Nguyen, D. V., Brunelli, S. M., Budoff, M. J., Streja, E., ... Kalantar-Zadeh, K. (2017). Thyroid status and mortality in a prospective hemodialysis cohort. Journal of Clinical Endocrinology and Metabolism, 102(5), 1568-1577. https://doi.org/10.1210/jc.2016-3616

Thyroid status and mortality in a prospective hemodialysis cohort. / Rhee, Connie M.; You, Amy S.; Nguyen, Danh V.; Brunelli, Steven M.; Budoff, Matthew J.; Streja, Elani; Nakata, Tracy; Kovesdy, Csaba P.; Brent, Gregory A.; Kalantar-Zadeh, Kamyar.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 102, No. 5, 01.05.2017, p. 1568-1577.

Research output: Contribution to journalArticle

Rhee, CM, You, AS, Nguyen, DV, Brunelli, SM, Budoff, MJ, Streja, E, Nakata, T, Kovesdy, CP, Brent, GA & Kalantar-Zadeh, K 2017, 'Thyroid status and mortality in a prospective hemodialysis cohort', Journal of Clinical Endocrinology and Metabolism, vol. 102, no. 5, pp. 1568-1577. https://doi.org/10.1210/jc.2016-3616
Rhee CM, You AS, Nguyen DV, Brunelli SM, Budoff MJ, Streja E et al. Thyroid status and mortality in a prospective hemodialysis cohort. Journal of Clinical Endocrinology and Metabolism. 2017 May 1;102(5):1568-1577. https://doi.org/10.1210/jc.2016-3616
Rhee, Connie M. ; You, Amy S. ; Nguyen, Danh V. ; Brunelli, Steven M. ; Budoff, Matthew J. ; Streja, Elani ; Nakata, Tracy ; Kovesdy, Csaba P. ; Brent, Gregory A. ; Kalantar-Zadeh, Kamyar. / Thyroid status and mortality in a prospective hemodialysis cohort. In: Journal of Clinical Endocrinology and Metabolism. 2017 ; Vol. 102, No. 5. pp. 1568-1577.
@article{77f4fa0015cf45da93bb7b3fb4fb4b27,
title = "Thyroid status and mortality in a prospective hemodialysis cohort",
abstract = "Context and Objective: Compared with the general population, hemodialysis patients have a substantially higher risk of hypothyroidism, as defined by an elevated serum thyrotropin (TSH) level, and cardiovascularmortality.Whereas an elevated TSHis associated with cardiovascular disease and death in the general population, associations among dialysis patients have been inconsistent. Design, Setting, Participants, and Main Outcome: We examined 541 hemodialysis patients from 17 southern California dialysis centers in the prospective Hypothyroidism, Cardiovascular Health, and Survival study who underwent protocolized measurement of repeated serum TSH levels every 6 months from 2013 to 2015. Associations between TSH tertiles (,1.28, 1.28 to ,2.14, and 2.14 to 86.7 mIU/L) and mortality were estimated using time-dependent Cox models with four adjustment levels. In sensitivity analyses, we excluded patients receiving thyroid hormone supplementation. Results: Compared with the lowest TSH tertile, the highest TSH tertile was associated with a 2.2-to 2.5-fold higher mortality risk in unadjusted, case-mix, expanded case-mix1laboratory, and expanded case-mix1laboratory1medication models [hazard ratios (95{\%} confidence interval), 2.54 (1.32 to 4.89), 2.53 (1.30 to 4.93), 2.19 (1.11 to 4.32), and 2.28 (1.45 to 3.58), respectively]. We observed a consistent trend between higher TSH tertiles and numerically higher mortality risk across all models. Similar findings were observed in analyses excluding patients receiving thyroid hormone supplementation. Conclusion: In time-dependent analyses, TSH levels in the high-normal to high range were independently associated with higher death risk in hemodialysis patients. Further studies are indicated to determine whether normalization of TSH levels with thyroid hormone supplementation improves survival in this population. (J Clin Endocrinol Metab 102: 1568-1577, 2017).",
author = "Rhee, {Connie M.} and You, {Amy S.} and Nguyen, {Danh V.} and Brunelli, {Steven M.} and Budoff, {Matthew J.} and Elani Streja and Tracy Nakata and Kovesdy, {Csaba P.} and Brent, {Gregory A.} and Kamyar Kalantar-Zadeh",
year = "2017",
month = "5",
day = "1",
doi = "10.1210/jc.2016-3616",
language = "English (US)",
volume = "102",
pages = "1568--1577",
journal = "Journal of Clinical Endocrinology and Metabolism",
issn = "0021-972X",
publisher = "The Endocrine Society",
number = "5",

}

TY - JOUR

T1 - Thyroid status and mortality in a prospective hemodialysis cohort

AU - Rhee, Connie M.

AU - You, Amy S.

AU - Nguyen, Danh V.

AU - Brunelli, Steven M.

AU - Budoff, Matthew J.

AU - Streja, Elani

AU - Nakata, Tracy

AU - Kovesdy, Csaba P.

AU - Brent, Gregory A.

AU - Kalantar-Zadeh, Kamyar

PY - 2017/5/1

Y1 - 2017/5/1

N2 - Context and Objective: Compared with the general population, hemodialysis patients have a substantially higher risk of hypothyroidism, as defined by an elevated serum thyrotropin (TSH) level, and cardiovascularmortality.Whereas an elevated TSHis associated with cardiovascular disease and death in the general population, associations among dialysis patients have been inconsistent. Design, Setting, Participants, and Main Outcome: We examined 541 hemodialysis patients from 17 southern California dialysis centers in the prospective Hypothyroidism, Cardiovascular Health, and Survival study who underwent protocolized measurement of repeated serum TSH levels every 6 months from 2013 to 2015. Associations between TSH tertiles (,1.28, 1.28 to ,2.14, and 2.14 to 86.7 mIU/L) and mortality were estimated using time-dependent Cox models with four adjustment levels. In sensitivity analyses, we excluded patients receiving thyroid hormone supplementation. Results: Compared with the lowest TSH tertile, the highest TSH tertile was associated with a 2.2-to 2.5-fold higher mortality risk in unadjusted, case-mix, expanded case-mix1laboratory, and expanded case-mix1laboratory1medication models [hazard ratios (95% confidence interval), 2.54 (1.32 to 4.89), 2.53 (1.30 to 4.93), 2.19 (1.11 to 4.32), and 2.28 (1.45 to 3.58), respectively]. We observed a consistent trend between higher TSH tertiles and numerically higher mortality risk across all models. Similar findings were observed in analyses excluding patients receiving thyroid hormone supplementation. Conclusion: In time-dependent analyses, TSH levels in the high-normal to high range were independently associated with higher death risk in hemodialysis patients. Further studies are indicated to determine whether normalization of TSH levels with thyroid hormone supplementation improves survival in this population. (J Clin Endocrinol Metab 102: 1568-1577, 2017).

AB - Context and Objective: Compared with the general population, hemodialysis patients have a substantially higher risk of hypothyroidism, as defined by an elevated serum thyrotropin (TSH) level, and cardiovascularmortality.Whereas an elevated TSHis associated with cardiovascular disease and death in the general population, associations among dialysis patients have been inconsistent. Design, Setting, Participants, and Main Outcome: We examined 541 hemodialysis patients from 17 southern California dialysis centers in the prospective Hypothyroidism, Cardiovascular Health, and Survival study who underwent protocolized measurement of repeated serum TSH levels every 6 months from 2013 to 2015. Associations between TSH tertiles (,1.28, 1.28 to ,2.14, and 2.14 to 86.7 mIU/L) and mortality were estimated using time-dependent Cox models with four adjustment levels. In sensitivity analyses, we excluded patients receiving thyroid hormone supplementation. Results: Compared with the lowest TSH tertile, the highest TSH tertile was associated with a 2.2-to 2.5-fold higher mortality risk in unadjusted, case-mix, expanded case-mix1laboratory, and expanded case-mix1laboratory1medication models [hazard ratios (95% confidence interval), 2.54 (1.32 to 4.89), 2.53 (1.30 to 4.93), 2.19 (1.11 to 4.32), and 2.28 (1.45 to 3.58), respectively]. We observed a consistent trend between higher TSH tertiles and numerically higher mortality risk across all models. Similar findings were observed in analyses excluding patients receiving thyroid hormone supplementation. Conclusion: In time-dependent analyses, TSH levels in the high-normal to high range were independently associated with higher death risk in hemodialysis patients. Further studies are indicated to determine whether normalization of TSH levels with thyroid hormone supplementation improves survival in this population. (J Clin Endocrinol Metab 102: 1568-1577, 2017).

UR - http://www.scopus.com/inward/record.url?scp=85019079794&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85019079794&partnerID=8YFLogxK

U2 - 10.1210/jc.2016-3616

DO - 10.1210/jc.2016-3616

M3 - Article

C2 - 28324018

AN - SCOPUS:85019079794

VL - 102

SP - 1568

EP - 1577

JO - Journal of Clinical Endocrinology and Metabolism

JF - Journal of Clinical Endocrinology and Metabolism

SN - 0021-972X

IS - 5

ER -