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      Clinical Implications of Subclinical Hypothyroidism in Continuous Ambulatory Peritoneal Dialysis Patients

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          Despite the high prevalence of subclinical hypothyroidism in patients with chronic kidney disease, little is known about the clinical features and implications of this disorder in end-stage renal disease patients. This study aimed to investigate the clinical implications of subclinical hypothyroidism in continuous ambulatory peritoneal dialysis (CAPD) patients. This is a cross-sectional study with 51 stable patients who were maintained on CAPD for more than 3 months. A thyroid function test with blood sampling and echocardiography were conducted. Subclinical hypothyroidism was defined as a thyrotropin (TSH) level over 5 mIU/l and normal free T(4). Of the 51 patients, subclinical hypothyroidism was detected in 14 (27.5%). Among those with subclinical hypothyroidism, only 4 (28.6%) patients had autoimmune thyroiditis. Patients with subclinical hypothyroidism had lower left ventricular ejection fractions (LVEF; 61.5 vs. 70.0%, p = 0.002) and lower fractional shortening at endocardial levels (endoFS; 33.9 vs. 40.0%, p = 0.009) compared to those with normal TSH levels. In addition, logTSH was inversely associated with LVEF (r = -0.361, p = 0.009) and endoFS (r = -0.320, p = 0.022). In a multivariate linear regression, adjusted for age, diabetes, previous coronary artery disease and logCRP (C-reactive protein), logTSH was an independent correlate with LVEF (beta = -0.388, p < 0.001). This study suggests that subclinical hypothyroidism is common and might be implicated in cardiac dysfunction in CAPD patients. Copyright 2008 S. Karger AG, Basel.

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          Most cited references 10

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          Association of Comorbid Conditions and Mortality in Hemodialysis Patients in Europe, Japan, and the United States: The Dialysis Outcomes and Practice Patterns Study (DOPPS)

           D Goodkin (2003)
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            Increased prevalence of subclinical and clinical hypothyroidism in persons with chronic kidney disease.

            Previous studies have suggested a higher prevalence of thyroid abnormalities in persons with end-stage renal disease. However, little is known regarding the epidemiology of thyroid disorders in persons with less severe kidney dysfunction. We used data from the Third National Health and Nutrition Examination Survey to examine the prevalence of hypothyroidism (clinical and subclinical) at different levels of estimated glomerular filtration rate (GFR). We used multivariable logistic regression to evaluate the association between GFR and prevalent hypothyroidism. Among 14,623 adult participants with serum creatinine and thyroid function test results, the mean age was 48.7 years, and 52.6% were women. The prevalence of hypothyroidism increased with lower levels of GFR (in units of mL/min/1.73 m(2)), occurring in 5.4% of subjects with GFR >/=90, 10.9% with GFR 60-89, 20.4% with GFR 45-59, 23.0% with GFR 30-44, and 23.1% with GFR /=90 mL/min/1.73 m(2), reduced GFR was associated with an increased risk of hypothyroidism, after adjusting for age, gender, and race/ethnicity: adjusted odds ratio 1.07 (95% confidence interval: 0.86-1.32) for GFR 60-89, 1.57 (1.11-2.22) for GFR 45-59, 1.81 (1.04-3.16) for GFR 30-44, and 1.97 (0.69-5.61) for GFR <30 mL/min/1.73 m(2) (P= 0.008 for trend). Among a nationally representative sample of adults, reduced glomerular filtration rate was associated with a higher prevalence of hypothyroidism, with many subclinical cases. Future studies are needed to determine the potential adverse effects of subclinical and clinical hypothyroidism in persons with chronic kidney disease.
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              Risk for ischemic heart disease and all-cause mortality in subclinical hypothyroidism.

              We investigated possible associations between subclinical hypothyroidism and atherosclerotic diseases (ischemic heart disease and cerebrovascular disease) and mortality. Of 2856 participants (mean age 58.5 yr) in a thyroid disease screening between 1984 and 1987, 257 subjects with subclinical hypothyroidism (TSH > 5.0 mU/liter) and 2293 control subjects (TSH range 0.6-5.0 mU/liter) were analyzed. In the baseline cross-sectional analysis, subclinical hypothyroidism was associated with ischemic heart disease independent of age, systolic blood pressure, body mass index, cholesterol, smoking, erythrocyte sedimentation rate, or presence of diabetes mellitus [odds ratio (OR), 2.5; 95% confidence interval (95% CI), 1.1-5.4 in total subjects and OR, 4.0; 95% CI, 1.4-11.5 in men] but not in women. However, there was no association with cerebrovascular disease (OR, 0.9; 95% CI, 0.4-2.4). We were unable to detect an influence of thyroid antibody presence on the association between subclinical hypothyroidism and ischemic heart disease. In a 10-yr follow-up study until 1998, increased mortalities from all causes in yr 3-6 after baseline measurement were apparent in men with subclinical hypothyroidism (hazard ratio, 1.9-2.1) but not in women, although specific causes of death were not determined. Our results indicate that subclinical hypothyroidism is associated with ischemic heart disease and might affect all-cause mortality in men.

                Author and article information

                Am J Nephrol
                American Journal of Nephrology
                S. Karger AG
                October 2008
                26 June 2008
                : 28
                : 6
                : 908-913
                Divisions of aNephrology and bEndocrinology, Department of Internal Medicine, NHIC Ilsan Hospital, Koyang, Kyungki-do, and cDepartment of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
                141933 Am J Nephrol 2008;28:908–913
                © 2008 S. Karger AG, Basel

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                Page count
                Pages: 6
                Kidney and beyond – Review Article


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