Thyroid Function, Cardiovascular Events, and Mortality in Diabetic Hemodialysis Patients
Abstract
Background In dialysis patients, the prevalence of thyroid disorders and their impact on specific cardiovascular (CV) events and mortality are largely unknown. The aim of the present study was to analyze whether subclinical thyroid disorders were associated with CV events and mortality. Study design Prospective multicenter cohort study. Setting & participants Thyroid status and clinical outcomes were explored in 1,000 diabetic hemodialysis patients from 178 centers in Germany. Predictor Thyroid status, defined by the following cutoff values: euthyroidism (thyrotropin [TSH], 0.30-4.0 mIU/L; free triiodothyronine [T3], 2.7-7.6 pmol/L; and free thyroxine [T4], 11.0-24.0 pmol/L), subclinical hyperthyroidism (TSH<0.3 mIU/L and free T3/free T4 within reference ranges), subclinical hypothyroidism (TSH, 4.1-15.0 mIU/L and free T3/free T4 within reference ranges), euthyroid sick syndrome (free T3<2.7 pmol/L and TSH/free T4 low or within reference ranges). Outcomes During 4 years' follow-up, prespecified adjudicated end points were determined: sudden cardiac death, myocardial infarction, stroke, combined CV events, and overall mortality. Short-term effects within the first 12 months were contrasted to long-term effects (years 2-4). Measurements TSH, free T3, and free T4 levels at baseline. Results Euthyroidism was present in 78.1% of patients; subclinical hyperthyroidism, in 13.7%; and subclinical hypothyroidism, in 1.6%. Euthyroid sick syndrome was exhibited by 5.4% of patients. The adjusted short-term risk of sudden cardiac death was more than doubled (HR, 2.03; 95% CI, 0.94-4.36) in patients with subclinical hyperthyroidism, and similarly for patients with euthyroid sick syndrome (HR, 2.74; 95% CI, 0.94-7.98) compared with patients with euthyroidism. Short-term mortality was increased almost 3-fold for patients with euthyroid sick syndrome (HR, 2.97; 95% CI, 1.66-5.29), but this effect was not seen in the long term. Subclinical hypothyroidism was not associated with CV events or all-cause mortality. Risks of stroke and myocardial infarction were not affected meaningfully by thyroid disorders. Limitations Observational study design. Conclusions Sudden cardiac death may be influenced by subclinical hyperthyroidism and euthyroid sick syndrome in the short term. Furthermore, euthyroid sick syndrome is associated strongly with mortality in hemodialysis patients. Regular assessment of thyroid status may help estimate the cardiac risk of dialysis patients.
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Two other studies included in a meta-analysis reported a non-significant decreased risk for stroke associated with subclinical hyperthyroidism.
“Contradicting this, two other studies included in this meta-analysis reported a non-significant decreased risk for stroke associated with SHyper [53,82] .”
From The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism (2015) · cites this paper as [82]
Cites
Hollowell, J. G., Staehling, N. W., Flanders, W. D., Hannon, W. H., Gunter, E. W., Spencer, C. A., & Braverman, L. E. (2002) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.87.2.489 · Cited by 4,279 · see citing works
Low Serum Thyrotropin Concentrations as a Risk Factor for Atrial Fibrillation in Older Persons
Sawin, C. T., Geller, A., Wolf, P. A., Belanger, A. J., Baker, E., Bacharach, P., Wilson, P., Benjamin, E. J., & D'Agostino, R. B. (1994) · New England Journal of Medicine · doi:10.1056/nejm199411103311901 · Cited by 1,259 · see citing works
Thyroid Status, Cardiovascular Risk, and Mortality in Older Adults
Cappola, A. R., Fried, L. P., Arnold, A. M., Danese, M. D., Kuller, L. H., Burke, G. L., Tracy, R. P., & Ladenson, P. W. (2006) · JAMA · doi:10.1001/jama.295.9.1033 · Cited by 862 · see citing works
Subclinical thyroid dysfunction as a risk factor for cardiovascular disease
Walsh, J. P., Bremner, A. P., Bulsara, M. K., O’Leary, P., Leedman, P. J., Feddema, P., & Michelangeli, V. (2005) · Archives of Internal Medicine · doi:10.1001/archinte.165.21.2467 · Cited by 536 · see citing works
Gencer, B., Collet, T.-H., Virgini, V., Bauer, D. C., Gussekloo, J., Cappola, A. R., Nanchen, D., den Elzen, W. P. J., Balmer, P., Luben, R. N., et al. (2012) · Circulation · doi:10.1161/circulationaha.112.096024 · Cited by 517 · see citing works
The Prevalence of Undiagnosed Thyroid Disorders in a Previously Iodine-Deficient Area
Völzke, H., Lüdemann, J., Robinson, D. M., Spieker, K. W., Schwahn, C., Kramer, A., John, U., & Meng, W. (2003) · Thyroid · doi:10.1089/105072503768499680 · Cited by 256 · see citing works
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Biondi, B., Bartalena, L., Cooper, D. S., Hegedüs, L., Laurberg, P., & Kahaly, G. J. (2015) · European Thyroid Journal · doi:10.1159/000438750 · Cited by 323 · see citing works
Moon, S., Kim, M. J., Yu, J. M., Yoo, H. J., & Park, Y. J. (2018) · Thyroid · doi:10.1089/thy.2017.0414 · Cited by 175 · see citing works
The interaction between thyroid and kidney disease: an overview of the evidence.
Rhee, C. M. (2016) · Current Opinion in Endocrinology, Diabetes & Obesity · doi:10.1097/med.0000000000000275 · Cited by 135 · see citing works
Thyroid Function and Sudden Cardiac Death: A Prospective Population-Based Cohort Study
Chaker, L., van den Berg, M. E., Niemeijer, M. N., Franco, O. H., Dehghan, A., Hofman, A., Rijnbeek, P. R., Deckers, J. W., Eijgelsheim, M., Stricker, B. H. C., et al. (2016) · Circulation · doi:10.1161/circulationaha.115.020789 · Cited by 97 · see citing works
Chaker, L., Baumgartner, C., den Elzen, W. P. J., Collet, T.-H., Ikram, M. A., Blum, M. R., Dehghan, A., Drechsler, C., Luben, R. N., Portegies, M. L. P., et al. (2016) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2016-2255 · Cited by 92 · see citing works
Self-citationSubclinical thyroid dysfunction and the risk of stroke: a systematic review and meta-analysis
Chaker, L., Baumgartner, C., Ikram, M. A., Dehghan, A., Medici, M., Visser, W. E., Hofman, A., Rodondi, N., Peeters, R. P., & Franco, O. H. (2014) · European Journal of Epidemiology · doi:10.1007/s10654-014-9946-8 · Cited by 72 · see citing works
Rhee, C. M., Kim, S., Gillen, D. L., Oztan, T., Wang, J., Mehrotra, R., Kuttykrishnan, S., Nguyen, D. V., Brunelli, S. M., Kovesdy, C. P., et al. (2015) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2014-4311 · Cited by 67 · see citing works
Sohn, S. Y., Lee, E., Lee, M. K., & Lee, J. H. (2020) · Endocrinology and Metabolism · doi:10.3803/enm.2020.728 · Cited by 60 · see citing works
Thyroid functional disease and mortality in a national peritoneal dialysis cohort.
Rhee, C. M., Ravel, V. A., Streja, E., Mehrotra, R., Kim, S., Wang, J., Nguyen, D. V., Kovesdy, C. P., Brent, G. A., & Kalantar-Zadeh, K. (2016) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2016-1691 · Cited by 36 · see citing works
- Authors
- Drechsler, C., Schneider, A., Gutjahr-Lengsfeld, L., Kroiss, M., Carrero, J. J., Krane, V., Allolio, B., Wanner, C., & Fassnacht, M.
- Affiliations
- University of Würzburg (DE)
- Karolinska Institutet (SE)
- Corresponding author
- Drechsler, Christiane
- ORCID
- Venue
- American Journal of Kidney Diseases
- Publisher
- Elsevier BV
- Published
- 2014-06
- Volume
- 63
- Issue
- 6
- Pages
- 988-996
- ISSN
- 0272-6386 (ISSN-L)
- OpenAlex
- W1982296064
- Cited by
- 70
- References
- 6
- Citations by year
- 2026: 3 · 2024: 4 · 2023: 6 · 2022: 6 · 2021: 5 · 2020: 7 · 2019: 3 · 2018: 8 · 2017: 6 · 2016: 11 · 2015: 7 · 2014: 4
- FWCI
- 5.76
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Kidney Diseases (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Keywords
- subclinical hyperthyroidism, subclinical hypothyroidism, low T3 syndrome, thyroid function, hemodialysis, diabetes mellitus, cardiovascular events, sudden cardiac death, mortality, thyroid-stimulating hormone, free thyroxine, free triiodothyronine, end-stage renal disease, stroke, myocardial infarction, cardiovascular risk stratification, prognostic factors
- MeSH terms
- Aged, Arrhythmias, Cardiac, Diabetes Mellitus, Type 2, Diabetic Nephropathies, Euthyroid Sick Syndromes, Female, Renal Dialysis, Humans, Hyperthyroidism, Hypothyroidism, Male, Middle Aged, Prospective Studies, Risk Factors, Thyroid Diseases, Death, Sudden, Cardiac, Hypertrophy, Left Ventricular
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