+ Resolve Article
+ Follow Us
Follow on FacebookFollow on Facebook
Follow on TwitterFollow on Twitter

+ Translate
+ Subscribe to Site Feed
GeoScience Most Shared ContentMost Shared Content

Thyroid function, cardiovascular events, and mortality in diabetic hemodialysis patients

, : Thyroid function, cardiovascular events, and mortality in diabetic hemodialysis patients. American Journal of Kidney Diseases 63(6): 988-996

In dialysis patients, the prevalence of thyroid disorders and their impact on specific cardiovascular (CV) events and mortality are largely unknown. The aim of the present study was to analyze whether subclinical thyroid disorders were associated with CV events and mortality. Prospective multicenter cohort study. Thyroid status and clinical outcomes were explored in 1,000 diabetic hemodialysis patients from 178 centers in Germany. Thyroid status, defined by the following cutoff values: euthyroidism (thyrotropin [TSH], 0.30-4.0 mIU/L; free triiodothyronine [T3], 2.7-7.6 pmol/L; and free thyroxine [T4], 11.0-24.0 pmol/L), subclinical hyperthyroidism (TSH<0.3 mIU/L and free T3/free T4 within reference ranges), subclinical hypothyroidism (TSH, 4.1-15.0 mIU/L and free T3/free T4 within reference ranges), euthyroid sick syndrome (free T3<2.7 pmol/L and TSH/free T4 low or within reference ranges). During 4 years' follow-up, prespecified adjudicated end points were determined: sudden cardiac death, myocardial infarction, stroke, combined CV events, and overall mortality. Short-term effects within the first 12 months were contrasted to long-term effects (years 2-4). TSH, free T3, and free T4 levels at baseline. Euthyroidism was present in 78.1% of patients; subclinical hyperthyroidism, in 13.7%; and subclinical hypothyroidism, in 1.6%. Euthyroid sick syndrome was exhibited by 5.4% of patients. The adjusted short-term risk of sudden cardiac death was more than doubled (HR, 2.03; 95% CI, 0.94-4.36) in patients with subclinical hyperthyroidism, and similarly for patients with euthyroid sick syndrome (HR, 2.74; 95% CI, 0.94-7.98) compared with patients with euthyroidism. Short-term mortality was increased almost 3-fold for patients with euthyroid sick syndrome (HR, 2.97; 95% CI, 1.66-5.29), but this effect was not seen in the long term. Subclinical hypothyroidism was not associated with CV events or all-cause mortality. Risks of stroke and myocardial infarction were not affected meaningfully by thyroid disorders. Observational study design. Sudden cardiac death may be influenced by subclinical hyperthyroidism and euthyroid sick syndrome in the short term. Furthermore, euthyroid sick syndrome is associated strongly with mortality in hemodialysis patients. Regular assessment of thyroid status may help estimate the cardiac risk of dialysis patients.


PMID: 24315768

DOI: 10.1053/j.ajkd.2013.10.009

Other references

Tidir, A.A.; Diachuk, V.V., 1976: Congenital subplical hemangioma of the larynx and trachea in an infant. Zhurnal Ushnykh, Nosovykh i Gorlovykh Boleznei 1): 98-100

Erdos, A., 1969: Investigations with phytoagglutinogens in inbred fowls. The " Hi " factor was studied by means of 6 phytoagglutinogens in an inbred strain of Brown Leghorns through 3 generations. Evidence was obtained that 2 genes, a dominant (HI) and a recessive (hi), exist at the Hi locus. Three genotypes,...

Mraz F., 1971: The cultivar mironovskaya and the powdery mildew erysiphe graminis f sp tritici in czechoslovakia. Sbornik Uvti (ustav Vedeckotechnickych Informaci) Ochrana Rostlin: 249-252

Sageman B.B., 1984: Paleoecology of a Cretaceous anoxic event. Abstracts - SEPM Midyear Meeting 1: 70

Sun Weidong; Bennett Vickie C.; Eggins Stephen M.; Arculus Richard J.; Perfit M.R., 2003: Rhenium systematics in submarine MORB and back-arc basin glasses; laser ablation ICP-MS results. Rhenium and other trace elements, including the moderately chalcophile elements Mo and Cu, were determined for 37 submarine basaltic glasses from the Lau and Coriolis Troughs (CT) back-arc basins and Woodlark marginal basin, as well as 30 mid-ocea...

Athias-Binche, Francoise, 1993: Dispersal in varying environments: The case of phoretic uropodid mites. Phoresy is a dispersal strategy in which one animal actively seeks out and attaches to another animal for transport. Phoretic dispersal is vital in many groups of mites that live in specialized microhabitats or unpredictable environments. This stu...

Lysenko M.P.; Katterfel d G.N.; Melua A.I., 1981: The zonation of soils on the Moon. Izvestiya Vsesoyuznogo Geograficheskogo Obshchestva 113(5): 438-441

Daenicke, R.O.lage, H., 1980: Tests on calf rearing based on cold drink procedures. Tierzuchter 32(5): 202-204

Baggot, G.P., 1980: The "you" in your case presentation. Dentalpractice 1(3): 66-67

Wallace, A.D.; Francis, S.S.; Shao, X.; de Smith, A.J.; Walsh, K.M.; Mckean-Cowdin, R.; Ma, X.; Dahl, G.; Barcellos, L.F.; Wiemels, J.L.; Metayer, C., 2017: A germ-line deletion of APOBEC3B does not contribute to subtype-specific childhood acute lymphoblastic leukemia etiology. Haematologica