9
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Thyroid Parameters and Kidney Disorder in Type 2 Diabetes: Results from the METAL Study

      research-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Objective

          Diabetic kidney disease is one of the most common microvascular complications of diabetes mellitus. We aimed to analyze the association of thyroid parameters with kidney disorders, especially in euthyroid participants.

          Methods

          The data were obtained from a cross-sectional study, the METAL study. Thyroid parameters, including thyroid-stimulating hormone (TSH), free triiodothyronine (FT 3), free thyroxine (FT 4), triiodothyronine (T 3), thyroxin (T 4), thyroid peroxidase antibody (TPOAb), and thyroglobulin antibody (TgAb), of 4136 participants with type 2 diabetes were measured. Two structure parameters of thyroid homeostasis, including the sum activity of step-up deiodinases (SPINA-G D) and thyroid secretory capacity (SPINA-G T), and two pituitary thyrotropic function indices, including Jostel's TSH index (TSHI) and the thyrotroph thyroid hormone resistance index (TTSI), were also calculated. Kidney disorders were described according to the presence of reduced estimated glomerular filtration rate (eGFR) and/or higher urinary albumin to creatinine ratio (UACR).

          Results

          The prevalence of kidney disorders increased with decreasing FT 3 or T 3 and increasing FT 4 or T 4 quartile levels (all P < 0.05). After full adjustment, linear regression showed that UACR levels were negatively associated with FT 3 and T 3 ( P < 0.001). In addition, eGFR was positively associated with FT 3 and T 3 and was negatively associated with TSH and FT 4 levels and TgAb positivity (all P < 0.05). By using binary logistic regression, higher TSH and FT 4 and lower FT 3 and T 3 were associated with kidney disorders (all P < 0.05). Similar results were seen in sensitivity analyses, which were performed in 3035 euthyroid diabetic participants; however, TSH was no longer related to them. The area under the receiver operating characteristic curve (AUROC) of lower FT 3 for existing kidney disorder was greater than that for any other thyroid hormones (all P < 0.001). The cutoff value of FT 3 for reduced eGFR was 4.39 pmol/L. Regarding thyroid homeostasis parameters, SPINA-G D was negatively associated with three statuses of kidney disorders, and TSHI and TTSI were positively associated with reduced eGFR (all P < 0.05).

          Conclusions

          Among patients with type 2 diabetes, elevated TSH and FT 4 (or T 4), lower FT 3 (or T 3), TgAb positivity, lower SPINA-G D, and higher TSHI and TTSI were associated with kidney disorders. The lower FT 3, even within the normal range (<4.38 pmol/L), may be the factor most related to reduced eGFR compared with other thyroid hormones in diabetic patients.

          Related collections

          Most cited references47

          • Record: found
          • Abstract: found
          • Article: not found

          Summary of KDIGO 2012 CKD Guideline: behind the scenes, need for guidance, and a framework for moving forward.

          The 2012 KDIGO Guideline for CKD evaluation, classification, and management has updated the original 2002 KDOQI Guidelines, using newer data and addressing issues raised over the last decade concerning definitions and assessment. This review highlights the key aspects of the CKD guideline, and describes the rationale for specific wording and the scope of the document. A précis of key concepts in each of the five sections of the guideline is presented. The guideline document is intended for general practitioners and nephrologists, and covers CKD evaluation, classification, and management for both adults and children. Throughout the guideline, we have attempted to overtly address areas of controversy or non-consensus, international relevance, and impact on practice and public policy.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Evaluation of the Chronic Kidney Disease Epidemiology Collaboration equation for estimating the glomerular filtration rate in multiple ethnicities.

            An equation from the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) provides more accurate estimates of the glomerular filtration rate (eGFR) than that from the modification of diet in renal disease (MDRD) Study, although both include a two-level variable for race (Black and White and other). Since creatinine generation differs among ethnic groups, it is possible that a multilevel ethnic variable would allow more accurate estimates across all groups. To evaluate this, we developed an equation to calculate eGFR that includes a four-level race variable (Black, Asian, Native American and Hispanic, and White and other) using a database of 8254 patients pooled from 10 studies. This equation was then validated in 4014 patients using 17 additional studies from the United States and Europe (validation database), and in 1022 patients from China (675), Japan (248), and South Africa (99). Coefficients for the Black, Asian, and Native American and Hispanic groups resulted in 15, 5, and 1% higher levels of eGFR, respectively, compared with the White and other group. In the validation database, the two-level race equation had minimal bias in Black, Native American and Hispanic, and White and other cohorts. The four-level ethnicity equation significantly improved bias in Asians of the validation data set and in Chinese. Both equations had a large bias in Japanese and South African patients. Thus, heterogeneity in performance among the ethnic and geographic groups precludes use of the four-level race equation. The CKD-EPI two-level race equation can be used in the United States and Europe across a wide range of ethnicity.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Chronic kidney disease: a public health priority and harbinger of premature cardiovascular disease.

              The epidemics of cardiovascular disease, obesity, diabetes, HIV and cancer have all received much attention from the public, media and policymakers. By contrast, chronic kidney disease (CKD) has remained largely a 'silent' epidemic. This is unfortunate because early diagnosis of renal disease based on proteinuria and/or reduced estimated glomerular filtration rate could enable early intervention to reduce the high risks of cardiovascular events, end-stage renal disease (ESRD) and death that are associated with CKD. Given the global increase in the incidence of the leading causes of CKD--hypertension, obesity and diabetes mellitus--better disease management and prevention planning are needed, as effective strategies are available to slow the progression of CKD and reduce cardiovascular risk. CKD may be regarded as a clinical model of accelerated vascular disease and premature ageing, and the risk-factor profile changes during the progression from mild/moderate CKD to ESRD. Although many randomized controlled trials in patients with mild to moderate CKD have shown beneficial effects of interventions aimed at preventing the progression of CKD, most trials have been unable to demonstrate a beneficial effect of interventions aimed at improving outcome in ESRD. Thus, novel treatment strategies are needed in this high-risk patient group. © 2010 The Association for the Publication of the Journal of Internal Medicine.
                Bookmark

                Author and article information

                Contributors
                Journal
                J Diabetes Res
                J Diabetes Res
                JDR
                Journal of Diabetes Research
                Hindawi
                2314-6745
                2314-6753
                2020
                28 March 2020
                : 2020
                : 4798947
                Affiliations
                Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
                Author notes

                Academic Editor: Ferdinando Carlo Sasso

                Author information
                https://orcid.org/0000-0003-3452-8412
                https://orcid.org/0000-0001-9591-6991
                https://orcid.org/0000-0002-5117-1614
                Article
                10.1155/2020/4798947
                7149438
                32337292
                785a86a1-bc87-4da1-ab07-405f204aa3e7
                Copyright © 2020 Yi Chen et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 7 January 2020
                : 3 March 2020
                : 9 March 2020
                Funding
                Funded by: School of Medicine, Shanghai Jiao Tong University
                Award ID: 19XJ11007
                Funded by: Municipal Human Resources Development Program for Outstanding Young Talents in Medical and Health Sciences in Shanghai
                Award ID: 2017YQ053
                Funded by: Commission of Health and Family Planning of Pudong District
                Award ID: PWZxq2017-17
                Funded by: Shanghai Municipal Education Commission
                Award ID: 2019-01-07-00-01-E00059
                Funded by: Science and Technology Commission of Shanghai Municipality
                Award ID: 18410722300
                Award ID: 19140902400
                Funded by: National Natural Science Foundation of China
                Award ID: 91857117
                Award ID: 81800694
                Categories
                Research Article

                Comments

                Comment on this article