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      Therapeutics and Clinical Risk Management (submit here)

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      The Correlation Between Low Serum T3 Levels and All-Cause and Cardiovascular Mortality in Peritoneal Dialysis Patients


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          This study is to investigate the correlation between serum triiodothyronine (T3) levels and all-cause and cardiovascular mortality in PD patients.


          A total of 376 end-stage renal disease (ESRD) patients who started maintenance PD treatment in the Department of Nephrology in our hospital and stable treatment for ≥3 months were selected, and the total T3 (TT3) and free T3 (FT3) levels were determined. Among them, 168 cases with FT3 <3.5 pmol/L and/or TT3 <0.92 nmol/L were divided into the low serum T3 level group, and the remaining 208 cases were divided into normal serum T3 level group. The Cox survival analysis method was used to analyze the correlation between low serum T3 levels and all-cause and cardiovascular mortality in PD patient.


          Compared with the normal serum T3 level group, patients with low serum T3 levels had higher systolic blood pressure and a higher proportion of heart disease, and lower levels of total T4, free T4, hemoglobin, serum albumin, blood calcium, serum total bilirubin, alanine aminotransferase, and 24-h urine volume (all P < 0.05). Binary Logistic regression analysis showed that heart disease (P = 0.003, OR: 2.628, 95% CI: 1.382–4.997) and high TT4 level (P < 0.001, OR: 0.968, 95% CI: 0.956–0.979) were related to low serum T3 levels in PD patients. Multivariate Cox regression analysis showed that low serum FT3 level was an independent risk factor for all-cause death in PD patients (HR = 0.633, 95% CI = 0.431–0.930; P < 0.020).


          Low serum T3 levels in PD patients were associated with heart disease and TT4 levels. Low serum FT3 levels were associated with the risk of all-cause death in PD patients.

          Most cited references34

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          Thyroid dysfunction and kidney disease: An update.

          Thyroid hormones influence renal development, kidney hemodynamics, glomerular filtration rate and sodium and water homeostasis. Hypothyroidism and hyperthyroidism affect renal function by direct renal effects as well as systemic hemodynamic, metabolic and cardiovascular effects. Hypothyroidism has been associated with increased serum creatinine and decreased glomerular filtration rate. The reverse effects have been reported in thyrotoxicosis. Most of renal manifestations of thyroid dysfunction are reversible with treatment. Kidney disease may also cause thyroid dysfunction by several mechanisms. Nephrotic syndrome has been associated to changes in serum thyroid hormone concentrations. Different forms of glomerulonephritis and tubulointerstitial disease may be linked to thyroid derangements. A high prevalence of thyroid hormone alteration has been reported in acute kidney injury. Thyroid dysfunction is highly prevalent in chronic kidney disease patients. Subclinical hypothyroidism and low triiodothyronine syndrome are common features in patients with chronic kidney disease. Patients treated by both hemodialysis and peritoneal dialysis, and renal transplantation recipients, exhibit thyroid hormone alterations and thyroid disease with higher frequency than that found in the general population. Drugs used in the therapy of thyroid disease may lead to renal complications and, similarly, drugs used in kidney disorders may be associated to thyroid alterations. Lastly, low thyroid hormones, especially low triiodothyronine levels, in patients with chronic kidney disease have been related to a higher risk of cardiovascular disease and all-cause mortality. Interpretation of the interactions between thyroid and renal function is a challenge for clinicians involved in the treatment of patients with thyroid and kidney disease.
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            Thyroid Dysfunction in Heart Failure and Cardiovascular Outcomes

            Background: The effects of thyroid dysfunction in patients with pre-existing heart failure have not been adequately studied. We examined the prevalence of thyroid dysfunction and associations with cardiovascular outcomes in a large, prospective cohort of outpatients with pre-existing heart failure. Methods and Results: We examined associations between thyroid dysfunction and New York Heart Association (NYHA) class, atrial fibrillation, and a composite endpoint of ventricular assist device placement, heart transplantation, or death in 1365 participants with heart failure enrolled in the Penn Heart Failure Study. Mean age was 57 years, 35% were women, and the majority had NYHA class II (45%) or III (32%) symptoms. More severe heart failure was associated with higher thyroid stimulating hormone, higher free thyroxine (FT4), and lower total triiodothyronine (TT3) concentrations (p<0.001 all models). Atrial fibrillation was positively associated with higher levels of FT4 alone (p≤0.01 all models). There were 462 composite endpoints over a median 4.2 years of follow-up. In adjusted models, compared to euthyroidism, subclinical hypothyroidism (TSH 4.51–19.99 mIU/L with normal FT4) was associated with an increased risk of the composite endpoint overall (hazard ratio [HR], 1.82; 95% confidence interval [CI], 1.27–2.61; p=0.001) and in the subgroup with TSH ≥ 7.00 mIU/L (HR, 3.25; 95% CI, 1.96–5.39; p<0.001), but not in the subgroup with TSH 4.51–6.99 mIU/L (HR, 1.26; 95% CI, 0.78–2.06; p= 0.34). Isolated low T3 was also associated with the composite endpoint (HR, 2.12; 95% CI, 1.65–2.72; p<0.001). Conclusions: In patients with pre-existing heart failure, subclinical hypothyroidism with TSH ≥ 7 mIU/L and isolated low T3 levels are associated with poor prognosis. Clinical trials are needed to explore therapeutic effects of T4 and T3 administration in heart failure.
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              Malnutrition, Inflammation, Atherosclerosis Syndrome (MIA) and Diet Recommendations among End-Stage Renal Disease Patients Treated with Maintenance Hemodialysis

              Malnutrition-inflammation-atherosclerosis syndrome is one of the causes of increased mortality in chronic kidney disease (CKD). The aim of the study was to assess the inflammation and nutritional status of patients in end-stage kidney disease treated with maintenance hemodialysis. The study included a group of 98 hemodialyzed patients with stage 5 CKD (38 women and 60 men). Albumin, prealbumin (PRE), and C-reactive protein (CRP) were measured in serum samples collected before mid-week dialysis. Fruit and vegetables frequency intakes were assessed with a questionnaire. CRP was above the reference limit of 5 mg/L in 53% of patients. Moreover, the Glasgow Prognostic Score (GPS) indicated the co-occurrence of inflammation and protein calorie malnutrition in 11% of patients, and the presence of either inflammation or malnutrition in 25%. The questionnaire revealed that hemodialyzed patients frequently exclude fruit and vegetables from their diets. Nearly 43% of the interviewed patients declared frequently eating vegetables, and 35% declared frequently eating fruit, a few times per week or less. The most frequently selected fruit and vegetables had a low antioxidant capacity. The strict dietary restrictions in CKD are difficult to fulfill, and if strictly followed, may lead to protein-calorie malnutrition.

                Author and article information

                Ther Clin Risk Manag
                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                19 August 2021
                : 17
                : 851-861
                [1 ]Department of Nephrology, Hwa Mei Hospital, University of Chinese Academy of Sciences , Ningbo, Zhejiang Province, 315010, People’s Republic of China
                [2 ]Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences , Ningbo, Zhejiang Province, 315010, People’s Republic of China
                Author notes
                Correspondence: Qun Luo Department of Nephrology, Hwa Mei Hospital, University of Chinese Academy of Sciences , No. 41, Northwest Street, Ningbo, Zhejiang Province, 315010, People’s Republic of ChinaTel/Fax +86-574-83870217 Email nbeyluoqun@126.com; luoqun@ucas.ac.cn
                Author information
                © 2021 Xu 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).

                : 15 June 2021
                : 10 August 2021
                Page count
                Figures: 2, Tables: 8, References: 34, Pages: 11
                Funded by: Ningbo Technology and Public Welfare Foundation, China;
                Funded by: Zhejiang Medical Science and Technology Research Foundation, China;
                Supported by Ningbo Technology and Public Welfare Foundation, China (Grant No. 2015C50038) and Zhejiang Medical Science and Technology Research Foundation, China, (Grant No. 2020KY258).
                Original Research

                serum t3 level,peritoneal dialysis,all-cause death,cardiovascular death,correlation
                serum t3 level, peritoneal dialysis, all-cause death, cardiovascular death, correlation


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