Dataset Information

Low thyroid function is not associated with an accelerated deterioration in renal function.

ABSTRACT: BACKGROUND:Chronic kidney disease (CKD) is frequently accompanied by thyroid hormone dysfunction. It is currently unclear whether these alterations are the cause or consequence of CKD. This study aimed at studying the effect of thyroid hormone alterations on renal function in cross-sectional and longitudinal analyses in individuals from all adult age groups. METHODS:Individual participant data (IPD) from 16 independent cohorts having measured thyroid stimulating hormone, free thyroxine levels and creatinine levels were included. Thyroid hormone status was defined using clinical cut-off values. Estimated glomerular filtration rates (eGFR) were calculated by means of the four-variable Modification of Diet in Renal Disease (MDRD) formula. For this IPD meta-analysis, eGFR at baseline and eGFR change during follow-up were computed by fitting linear regression models and linear mixed models in each cohort separately. Effect estimates were pooled using random effects models. RESULTS:A total of 72 856 individuals from 16 different cohorts were included. At baseline, individuals with overt hypothyroidism (n?=?704) and subclinical hypothyroidism (n?=?3356) had a average (95% confidence interval) -4.07 (-6.37 to -1.78) and -2.40 (-3.78 to -1.02) mL/min/1.73?m2 lower eGFR as compared with euthyroid subjects (n?=?66 542). In (subclinical) hyperthyroid subjects (n?=?2254), average eGFR was 3.01 (1.50-4.52) mL/min/1.73?m2 higher. During 329 713 patient years of follow-up, eGFR did not decline more rapidly in individuals with low thyroid function compared with individuals with normal thyroid function. CONCLUSIONS:Low thyroid function is not associated with a deterioration of renal function. The cross-sectional association may be explained by renal dysfunction causing thyroid hormone alterations.

SUBMITTER: Meuwese CL

PROVIDER: S-EPMC6452200 | biostudies-literature | 2019 Apr

REPOSITORIES: biostudies-literature

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Low thyroid function is not associated with an accelerated deterioration in renal function.

Meuwese Christiaan L CL van Diepen Merel M Cappola Anne R AR Sarnak Mark J MJ Shlipak Michael G MG Bauer Douglas C DC Fried Linda P LP Iacoviello Massimo M Vaes Bert B Degryse Jean J Khaw Kay-Tee KT Luben Robert N RN Åsvold Bjørn O BO Bjøro Trine T Vatten Lars J LJ de Craen Anton J M AJM Trompet Stella S Iervasi Giorgio G Molinaro Sabrina S Ceresini Graziano G Ferrucci Luigi L Dullaart Robin P F RPF Bakker Stephan J L SJL Jukema J Wouter JW Kearney Patricia M PM Stott David J DJ Peeters Robin P RP Franco Oscar H OH Völzke Henry H Walsh John P JP Bremner Alexandra A Sgarbi José A JA Maciel Rui M B RMB Imaizumi Misa M Ohishi Waka W Dekker Friedo W FW Rodondi Nicolas N Gussekloo Jacobijn J den Elzen Wendy P J WPJ

Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association 20190401 4

<h4>Background</h4>Chronic kidney disease (CKD) is frequently accompanied by thyroid hormone dysfunction. It is currently unclear whether these alterations are the cause or consequence of CKD. This study aimed at studying the effect of thyroid hormone alterations on renal function in cross-sectional and longitudinal analyses in individuals from all adult age groups.<h4>Methods</h4>Individual participant data (IPD) from 16 independent cohorts having measured thyroid stimulating hormone, free thyr ...[more]

PMID: 29684213

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Project description:Background and objectivesThe notion that oral intestinal sorbent AST-120 slows renal disease progression has not been evaluated thoroughly. In this study, we investigated the long-term effect of AST-120 on renal disease progression (doubling of serum creatinine, eGFR decrease >50%, or initiation of RRT) in patients with advanced CKD.Design, setting, participants, & measurementsWe prospectively recruited 579 patients (CKD stage 3 or 4) from 11 medical centers in Korea from March 4, 2009 to August 31, 2010 and randomized them into an AST-120 arm and a control arm. Patients in the AST-120 arm were given 6 g AST-120 in three divided doses per day, and those in the control arm received only standard conventional treatment (open-label design) for 36 months or until the occurrence of primary outcomes.ResultsLevels of serum and urine indoxyl sulfate and β2-microglobulin decreased throughout the study period in both treatment arms; however, there was not a significant difference in change in uremic toxins in the AST-120 and control arms. The two arms were not different in the occurrence of composite primary outcomes (100 events in 272 individuals in the AST-120 arm and 100 events in 266 individuals in the control arm; hazard ratio, 1.12; 95% confidence interval, 0.85 to 1.48; log-rank P=0.45). The decline in eGFR and change in proteinuria were similar in the two treatment arms over time (Prandomization-time=0.64 and Prandomization-time=0.16, respectively). There was no difference in mortality (nine deaths in the AST-120 arm and 11 deaths in the control arm; log-rank P=0.73) or unplanned hospitalizations (102 in the AST-120 arm and 109 in the control arm; log-rank P=0.76) in the two treatment arms. There was no significant difference of the health-related quality of life score between the two arms.ConclusionsLong-term use of AST-120 added to standard treatment did not change renal disease progression, proteinuria, mortality, and health-related quality of life in patients with advanced renal dysfunction.

Project description:BackgroundThe burden of metabolic syndrome (MetS) continues to rise globally and is associated with complications of multiple organ systems. We aimed to identify the association between changes in MetS status and accelerated renal function progression through a regional epidemiological survey in China, thus discovering influence factors with treatable potential.MethodsThis study was a population-based survey conducted in 2008 and 2014, assessing a representative sample of 5,225 individuals from rural areas of China. They were divided into four subgroups according to their MetS status in 2008 and 2014 (Never, Previously abnormal, New-onset, and Consistent). Multivariate logistic regression and stratification analysis evaluated the relationship between clinical factors and renal function decline under different MetS statuses. Smooth curve fitting further addressed the role of serum uric acid, illustrating the vital turning point of uric acid levels in the background of renal function deterioration.ResultsOf all groups of MetS states, the new-onset MetS showed the most significant eGFR decline, with a 6.66 ± 8.21 mL/min/1.73 m2 decrease over 6 years. The population with newly-onset MetS showed a considerable risk increase in delta eGFR with a beta coefficient of 1.66 (95%CI=1.09-2.23) after necessary correction. In searching for the drivers, the strength of the association was significantly reduced after additional adjustment for uric acid levels (β=0.91, 95%CI=0.35-1.45). Regarding the turning point, uric acid levels exceeding 426 μmol/L were more significantly associated with the stepped-up deterioration of kidney function for those with new-onset MetS.ConclusionMetabolic syndrome demonstrated a solid correlation with the progression of renal function, particularly in those with newly-onset MetS status. In addition to the diagnostic components of MetS, hyperuricemia could be used as a marker to identify the high risk of accelerating eGFR decline early. Furthermore, we suggested a potential renal benefit for the newly-onset MetS population when maintaining their serum uric acid level below the criteria for asymptomatic hyperuricemia.

Dataset Information

Low thyroid function is not associated with an accelerated deterioration in renal function.

Publications

Low thyroid function is not associated with an accelerated deterioration in renal function.

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