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Cited by 67Thyroid Disorders and TreatmentsDialysis and Renal Disease ManagementThyroid and Parathyroid Surgery

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

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Rhee, Connie M., Kim, Steven, Gillen, Daniel L., Oztan, Tolga, Wang, Jiaxi, Mehrotra, Rajnish, Kuttykrishnan, Sooraj, Nguyen, Danh V. +4 more·2015·The Journal of Clinical Endocrinology & Metabolism
DOI 10.1210/jc.2014-4311PMC PMC4399303
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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, we examined the association of hypothyroidism (TSH Ͼ5.0 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, we examined the impact of low-normal, upper-normal, subclinical range, and overt range TSH levels (TSH Ն0.5-3.0,Ͼ3.0 -5.0, Ͼ5.0 -10.0, and Ͼ10.0 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.(J Clin Endocrinol Metab 100: 1386 -1395, 2015) D ata spanning over three decades show that hypothy- roidism is highly prevalent in predialysis and dialysis-dependent chronic kidney disease patients (1-10).For example, data from the Third National Health and Nutrition Examination Survey (NHANES III) demonstrate an increasing prevalence of hypothyroidism with incrementally impaired kidney function: 5.4, 10.9, 20.4,23.0, and 23.1% with estimated glomerular filtration rates of Ն90, 60 -89, 45-59, 30 -44, and Ͻ30 mL/min/1.73m 2 , respectively (6).Although prevalence estimates vary across populations, epidemiological data show a disproportionately higher burden of hypothyroidism in hemodialysis (HD) patients (4, 5, 8, 9).Indeed, many cases may remain latent or undiagnosed due to symptom

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  • Rhee and colleagues reported an association between high-normal TSH concentrations and mortality among people with chronic kidney disease, including those receiving dialysis.

    “Rhee and colleagues15,16 have reported an association between high-normal TSH concentrations and mortality among people with chronic kidney disease, including those who are receiving dialysis.”

    From Association of subclinical hypothyroidism and cardiovascular disease with mortality (2020) · cites this paper as [16]

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Research works printed but not linked: 2

  1. Donati RM, Fletcher JW, Warnecke MA, Gallagher NI. Erythro- poiesis in hypothyroidism. Proc Soc Exp Biol Med. 1973;144(1): 78 -82.
  2. Soldin OP. Measuring serum thyroid-stimulating hormone, thyroid hormones, thyroid-directed antibodies, and transport proteins. In: Braverman LE, Cooper DS, eds. Werner and Ingbar's The Thyroid. 10th ed. Chap 13A. Philadelphia, PA: Lippincott Williams and Wilkins; 2012:279 -296.

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Authors
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., Brent, G. A., & Kalantar-Zadeh, K.
Affiliations
  • University of Tennessee Health Science Center (US)
  • University of California, Irvine (US)
  • University of Washington (US)
  • University of California, Irvine Medical Center (US)
  • DaVita Clinical Research (United States) (US)
  • University of California, Los Angeles (US)
Corresponding author
Rhee, Connie M.
ORCID
Venue
The Journal of Clinical Endocrinology & Metabolism
Publisher
The Endocrine Society
Published
2015-04
Volume
100
Issue
4
Pages
1386-1395
ISSN
  • 0021-972X (ISSN-L)
  • 1945-7197
DOI
10.1210/jc.2014-4311
PMC
PMC4399303
OpenAlex
W2043414544
Cited by
67
References
75
Citations by year
2026: 3 · 2025: 3 · 2024: 5 · 2023: 8 · 2022: 6 · 2021: 5 · 2020: 8 · 2019: 6 · 2018: 6 · 2017: 8 · 2016: 7 · 2015: 2
FWCI
6.66
Type
journal article
Language
en
Open access
Locations
  • The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • eScholarship (California Digital Library) (submittedVersion, cc-by)
Funders
  • U.S. Department of Veterans Affairs (I01 BX001966)
  • National Institutes of Health (UL1TR000153)
  • National Institute of Diabetes and Digestive and Kidney Diseases (R01DK078106, R01DK096920, K23DK102903, F32DK009568, K24DK091419, U01DK102163, R01DK098576, R01-DK09568)
  • National Center for Advancing Translational Sciences
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
hemodialysis patients, mortality, thyroid-stimulating hormone, subclinical hypothyroidism, all-cause mortality, body mass index, thyroid hormone replacement, end-stage renal disease, chronic kidney disease, cardiovascular risk, time-dependent analysis, risk adjustment, dialysis adequacy
MeSH terms
Aged, Aged, 80 and over, Cardiovascular Diseases, Cause of Death, Female, Renal Dialysis, Humans, Hypothyroidism, Male, Middle Aged, Thyroid Function Tests, Thyrotropin, United States, Cohort Studies, Incidence, Survival Analysis, Renal Insufficiency, Chronic

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