Thyroid Status, Quality of Life, and Mental Health in Patients on Hemodialysis

Abstract

<div class="section"> <a class="named-anchor" id="d6501016e264"> <!-- named anchor --> </a> <h5 class="section-title" id="d6501016e265">Background and objectives</h5> <p id="d6501016e267">In the general population, there is increasing recognition of the effect of thyroid function on patient-centered outcomes, including health-related quality of life and depression. Although hypothyroidism is highly prevalent in hemodialysis patients, it is unknown whether thyroid status is a risk factor for impaired health-related quality of life or mental health in this population. </p> </div><div class="section"> <a class="named-anchor" id="d6501016e269"> <!-- named anchor --> </a> <h5 class="section-title" id="d6501016e270">Design, setting, participants, &amp; measurements</h5> <p id="d6501016e272">We examined the association of thyroid status, defined by serum thyrotropin, with health-related quality of life and depressive symptoms over time in a prospective cohort of 450 patients on hemodialysis from 17 outpatient dialysis facilities from May of 2013 to May of 2015 who underwent protocolized thyrotropin testing, Short-Form 36 surveys, and Beck Depression Inventory-II questionnaires every 6 months. We examined the association of baseline and time-dependent thyrotropin categorized as tertiles and continuous variables with eight Short-Form 36 domains and Beck Depression Inventory-II scores using expanded case mix plus laboratory adjusted linear mixed effects models. </p> </div><div class="section"> <a class="named-anchor" id="d6501016e274"> <!-- named anchor --> </a> <h5 class="section-title" id="d6501016e275">Results</h5> <p id="d6501016e277">In categorical analyses, the highest baseline thyrotropin tertile was associated with a five-point lower Short-Form 36 domain score for energy/fatigue ( <i>P</i>=0.04); the highest time-dependent tertile was associated with a five-point lower physical function score ( <i>P</i>=0.03; reference: lowest tertile). In continuous analyses, higher baseline serum thyrotropin levels (+ <i>Δ</i>1 mIU/L) were associated with lower role limitations due to physical health ( <i>β</i>=−1.3; <i>P</i>=0.04), energy/fatigue ( <i>β</i>=−0.8; <i>P</i>=0.03), and pain scores ( <i>β</i>=−1.4; <i>P</i>=0.002), equivalent to five-, three-, and five-point lower scores, respectively, for every 1-SD higher thyrotropin. Higher time-dependent thyrotropin levels were associated with lower role limitations due to physical health scores ( <i>β</i>=−1.0; <i>P</i>=0.03), equivalent to a three-point decline for every 1-SD higher thyrotropin. Baseline and time-dependent thyrotropin were not associated with Beck Depression Inventory-II scores. </p> </div><div class="section"> <a class="named-anchor" id="d6501016e313"> <!-- named anchor --> </a> <h5 class="section-title" id="d6501016e314">Conclusions</h5> <p id="d6501016e316">In patients on hemodialysis, higher serum thyrotropin levels are associated with impaired health-related quality of life across energy/fatigue, physical function, and pain domains. Studies are needed to determine if thyroid-modulating therapy improves the health-related quality of life of hemodialysis patients with thyroid dysfunction. </p> </div><p class="first" id="d6501016e319"> <div class="fig panel" id="absf1"> <a class="named-anchor" id="absf1"> <!-- named anchor --> </a> <div class="figure-container so-text-align-c"> <img alt="" class="figure" src="/document_file/004b428b-5300-476a-8e56-2efb2c53e96e/PubMedCentral/image/CJN.13211216absf1"/> </div> <div class="panel-content"/> </div> </p>