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

ABSTRACT: 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.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.In categorical analyses, the highest baseline thyrotropin tertile was associated with a five-point lower Short-Form 36 domain score for energy/fatigue (P=0.04); the highest time-dependent tertile was associated with a five-point lower physical function score (P=0.03; reference: lowest tertile). In continuous analyses, higher baseline serum thyrotropin levels (+?1 mIU/L) were associated with lower role limitations due to physical health (?=-1.3; P=0.04), energy/fatigue (?=-0.8; P=0.03), and pain scores (?=-1.4; P=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 (?=-1.0; P=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.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.

SUBMITTER: Rhee CM

PROVIDER: S-EPMC5544520 | biostudies-literature | 2017 Aug

REPOSITORIES: biostudies-literature

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

Rhee Connie M CM Chen Yanjun Y You Amy S AS Brunelli Steven M SM Kovesdy Csaba P CP Budoff Matthew J MJ Brent Gregory A GA Kalantar-Zadeh Kamyar K Nguyen Danh V DV

Clinical journal of the American Society of Nephrology : CJASN 20170713 8

<h4>Background and objectives</h4>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.<h4>Design, setting, participants, & measurements</h4>We examined the association ...[more]

PMID: 28705886

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Project description:This study aimed to investigate the quality of life and mental health status and further to identify relevant risk factors among advanced cancer patients with spine metastases. This study prospectively included and analyzed 103 advanced cancer patients with spine metastases. Patient's basic information, lifestyles, comorbidities, tumor characteristics, therapeutic strategies, economic conditions, quality of life, anxiety, and depression were collected. Patient's quality of life was assessed using the Functional Assessment of Cancer Therapy-General Scale (FACT-G), and anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale (HADS). Subgroup analysis was performed based on different age groups, and a multivariate analysis was performed to test the ability of 20 potential risk factors to predict quality of life, anxiety, and depression. The mean total FACT-G score was only 61.38 ± 21.26. Of all included patients, 52.43% had skeptical or identified anxiety and 53.40% suffered from skeptical or identified depression. Patients had an age of 60 or more and <70 years had the lowest FACT-G score (54.91 ± 19.22), highest HADS anxiety score (10.25 ± 4.22), and highest HADS depression score (10.13 ± 4.94). After adjusting all other potential risk factors, age was still significantly associated with quality of life (OR = 0.57, 95%CI: 0.38-0.86, p < 0.01) and depression (OR = 1.55, 95%CI: 1.00-2.42, p = 0.05) and almost significantly associated with anxiety (OR = 1.52, 95%CI: 0.94-2.43, p = 0.08). Besides, preference to eating vegetables, time since knowing cancer diagnosis, surgical treatment at primary cancer, hormone endocrine therapy, and economic burden due to cancer treatments were found to be significantly associated with the quality of life. A number of comorbidities and economic burden due to cancer treatments were significantly associated with anxiety. Advanced cancer patients with spine metastases suffer from poor quality of life and severe anxiety and depression, especially among patients with an age of 60 or more and <70 years. Early mental health care and effective measures should be conducted to advanced cancer patients with spine metastases, and more attention should be paid to take care of patients with an age of 60 or more and <70 years in terms of their quality of life and mental health status.

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Dataset Information

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

Publications

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

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