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Cited by 36Thyroid Disorders and TreatmentsDialysis and Renal Disease ManagementThyroid and Parathyroid Surgery

Thyroid functional disease and mortality in a national peritoneal dialysis cohort.

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Rhee, Connie M., Ravel, Vanessa A., Streja, Elani, Mehrotra, Rajnish, Kim, Steven, Wang, Jiaxi, Nguyen, Danh V., Kovesdy, Csaba P. +2 more·2016·The Journal of Clinical Endocrinology & Metabolism
DOI 10.1210/jc.2016-1691PMC PMC5095247
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Abstract

CONTEXT AND OBJECTIVE: End-stage renal disease patients have a higher risk of thyroid disease compared with those without kidney disease. Although thyroid dysfunction is associated with higher death risk in the general population and those undergoing hemodialysis, little is known about the effect of thyroid disease upon mortality in patients treated with peritoneal dialysis (PD). DESIGN, SETTING, PARTICIPANTS, AND MAIN OUTCOME: We examined the association of thyroid status, assessed by serum TSH, with all-cause mortality among PD patients from a large national dialysis organization who underwent one or more TSH measurements over 5 years (January 2007 to December 2011). Thyroid status was categorized as overt-hyperthyroid, subclinical-hyperthyroid, low-normal, high-normal, subclinical-hypothyroid, and overt-hypothyroid range (TSH < 0.1, 0.1–<0.5, 0.5–<3.0, 3.0–<5.0, 5.0–<10.0, and ≥10.0 mIU/L, respectively). We examined the association between TSH and mortality using case mix–adjusted time-dependent Cox models to assess short-term thyroid function–mortality associations and to account for changes in thyroid function over time. RESULTS: Among 1484 patients, 7 and 18% had hyperthyroidism and hypothyroidism, respectively, at baseline. We found that both lower and higher time-dependent TSH levels were associated with higher mortality (reference: TSH, 0.5-<3.0 mIU/L): adjusted hazard ratios (95% confidence intervals) 2.09 (1.08-4.06), 1.53 (0.87-2.70), 1.05 (0.75-1.46), 1.63 (1.11-2.40), and 3.11 (2.08-4.63) for TSH levels, <0.1, 0.1-<0.5, 0.5-<3.0, 3.0-<5.0, 5.0-<10.0, and ≥10.0 mIU/L, respectively. CONCLUSION: Time-dependent TSH levels < 0.1 mIU/L and ≥ 5.0 mIU/L were associated with higher mortality, suggesting hyper- and hypothyroidism carry short-term risk in PD patients. Additional studies are needed to determine mechanisms underlying the thyroid dysfunction-mortality association, and whether normalization of TSH with treatment ameliorates mortality in this population.

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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 [15]

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Authors
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.
Affiliations
  • University of California, Irvine (US)
  • University of Washington (US)
  • California State University, Monterey Bay (US)
  • University of Tennessee Health Science Center (US)
  • University of California, Los Angeles (US)
  • Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension (C.M.R., V.A.R., E.S., J.W., K.K.-Z.), University of California–Irvine, Orange, California 92868;
Corresponding author
Rhee, Connie M.
ORCID
Venue
The Journal of Clinical Endocrinology & Metabolism
Publisher
The Endocrine Society
Published
2016-08-15
Volume
101
Issue
11
Pages
4054-4061
ISSN
  • 0021-972X (ISSN-L)
  • 1945-7197
DOI
10.1210/jc.2016-1691
PMC
PMC5095247
OpenAlex
W2518377639
Cited by
36
References
40
Citations by year
2026: 1 · 2025: 3 · 2024: 4 · 2023: 5 · 2022: 4 · 2021: 1 · 2020: 5 · 2019: 4 · 2018: 5 · 2017: 4
FWCI
4.35
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
  • American Society of Nephrology
  • International Society of Nephrology
  • National Institutes of Health (UL1TR001414, UL1TR000153)
  • University of California, Irvine
  • National Institute of Diabetes and Digestive and Kidney Diseases (R01DK078106, R01DK096920, K23DK102903, F32DK009568, K24DK091419, U01DK102163, R01DK092232)
  • 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
thyroid dysfunction, peritoneal dialysis, end-stage renal disease, all-cause mortality, thyroid-stimulating hormone, subclinical hypothyroidism, subclinical hyperthyroidism, overt hypothyroidism, overt hyperthyroidism, dialysis patients, risk adjustment, time-dependent Cox model
MeSH terms
Adult, Aged, Female, Humans, Hyperthyroidism, Hypothyroidism, Kidney Failure, Chronic, Male, Middle Aged, Peritoneal Dialysis, Thyrotropin, United States

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