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 language | English (US) |
|---|---|
| Pages (from-to) | 1568-1577 |
| Number of pages | 10 |
| Journal | Journal of Clinical Endocrinology and Metabolism |
| Volume | 102 |
| Issue number | 5 |
| DOIs | |
| State | Published - May 1 2017 |
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ASJC Scopus subject areas
- Endocrinology, Diabetes and Metabolism
- Biochemistry
- Endocrinology
- Clinical Biochemistry
- Biochemistry, medical
Cite this
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 journal › Article
}
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 -