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      The Correlation between Thyroid Hormone Levels and the Kidney Disease Progression Risk in Patients with Type 2 Diabetes

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          Abstract

          Objective

          We investigated the relationship between thyroid hormones and the risk of diabetic kidney disease (DKD) progression.

          Methods

          A total of 452 patients with type 2 diabetes were included, and a cross-sectional analysis was performed. Urine albumin/creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR) were used to diagnose persistent albuminuria and stage chronic kidney disease, respectively. The Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guideline was used to describe the risk of DKD progression (low, moderate, and high or very high risks).

          Results

          The DKD group had higher levels of thyroid-stimulating hormone (TSH) and lower levels of free triiodothyronine (FT 3) and free thyroxine (FT 4) than the non-DKD group. The prevalence of thyroid dysfunction in the DKD group was significantly higher than in the non-DKD group, especially the prevalence of subclinical hypothyroidism. FT 3 levels decreased gradually with the deterioration of DKD. TSH levels increased with an increasing KDIGO category. FT 3 and FT 4 levels were negatively correlated with serum creatinine levels and ACR, and positively correlated with eGFR. Contrastingly, TSH was positively correlated with ACR, and negatively correlated with eGFR. After adjustment, an increase in FT 3 levels significantly reduced the risk of DKD [odds ratio, OR (95% confidence interval, CI)=0.58 (0.42–0.79)] and DKD progression [ORs (95% CIs)=0.65 (0.45–0.93) for the moderate risk group and 0.50 (0.33–0.74) for the high or very high-risk group, using the low-risk group as a reference]. FT 3 levels below 4.30 pmol/L in men and 3.99 pmol/L in women were the cut-off points for an increased risk of DKD progression.

          Conclusion

          Low FT 3 level is an independent risk factor for DKD and DKD progression. FT 3 ≤4.30 pmol/L in men and ≤3.99 pmol/L in women will greatly increase the risk of kidney disease progression in patients with type 2 diabetes.

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          Most cited references43

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          Diabetic Kidney Disease: Challenges, Progress, and Possibilities.

          Diabetic kidney disease develops in approximately 40% of patients who are diabetic and is the leading cause of CKD worldwide. Although ESRD may be the most recognizable consequence of diabetic kidney disease, the majority of patients actually die from cardiovascular diseases and infections before needing kidney replacement therapy. The natural history of diabetic kidney disease includes glomerular hyperfiltration, progressive albuminuria, declining GFR, and ultimately, ESRD. Metabolic changes associated with diabetes lead to glomerular hypertrophy, glomerulosclerosis, and tubulointerstitial inflammation and fibrosis. Despite current therapies, there is large residual risk of diabetic kidney disease onset and progression. Therefore, widespread innovation is urgently needed to improve health outcomes for patients with diabetic kidney disease. Achieving this goal will require characterization of new biomarkers, designing clinical trials that evaluate clinically pertinent end points, and development of therapeutic agents targeting kidney-specific disease mechanisms (e.g., glomerular hyperfiltration, inflammation, and fibrosis). Additionally, greater attention to dissemination and implementation of best practices is needed in both clinical and community settings.
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            KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease

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              11. Microvascular Complications and Foot Care: Standards of Medical Care in Diabetes—2021

              (2020)
              The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc21-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc21-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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                Author and article information

                Journal
                Diabetes Metab Syndr Obes
                Diabetes Metab Syndr Obes
                dmso
                Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy
                Dove
                1178-7007
                05 January 2022
                2022
                : 15
                : 59-67
                Affiliations
                [1 ]Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Nanchang University , Nanchang, 330008, Jiangxi, People’s Republic of China
                [2 ]Department of Endocrinology and Metabolism, The Third Hospital of Nanchang , Nanchang, 330000, Jiangxi, People’s Republic of China
                [3 ]Jiangxi Medical College of Nanchang University , Nanchang, 330036, Jiangxi, People’s Republic of China
                [4 ]Jiangxi University of Traditional Chinese Medicine , Nanchang, 330004, Jiangxi, People’s Republic of China
                Author notes
                Correspondence: Xiaoyang Lai Tel +86 13607916298 Email 1640852510@qq.com
                Article
                347862
                10.2147/DMSO.S347862
                8743497
                35023940
                bf425038-6b71-48fa-a0b8-6308702c022f
                © 2022 Yang et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                : 12 November 2021
                : 15 December 2021
                Page count
                Figures: 2, Tables: 12, References: 43, Pages: 9
                Funding
                Funded by: the National Natural Science Foundation of China;
                Funded by: the Key Research and Development Programs by Science and Technology Department of Jiangxi Province;
                Funded by: the Science and Technology Support Project by Science and Technology Department of Nanchang City;
                This work was supported by the National Natural Science Foundation of China [grant number 81760153, Recipient: Peng Duan], the Key Research and Development Programs by Science and Technology Department of Jiangxi Province [grant numbers 20171BBG70058, 20171ACH80002 and 20181BBG70014, Recipient: Zhi Yang, Ping Tu and Jiang Liu], the Science and Technology Support Project by Science and Technology Department of Nanchang City [grant number [2020]133, Recipient: Peng Duan].
                Categories
                Original Research

                Endocrinology & Diabetes
                thyroid hormone,prognosis of chronic kidney disease,type 2 diabetes mellitus

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