American Journal of Nephrology
Original Report: Patient-Oriented, Translational Research
Nutritional State Alters the Association between Free Triiodothyronine Levels and Mortality in Hemodialysis PatientsOzen K.P.a · Asci G.b · Gungor O.b · Carrero J.J.c · Kircelli F.b · Tatar E.b · Sevinc Ok E.b · Ozkahya M.b · Toz H.b · Cirit M.a · Basci A.b · Ok E.baDivision of Nephrology, Ataturk Training and Research Hospital, and bDivision of Nephrology, Ege University School of Medicine, Izmir, Turkey; cDivision of Renal Medicine, Centre for Gender Medicine and Centre for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
|
|
Log in to MyKarger to check if you already have access to this content.
KAB
Buy a Karger Article Bundle (KAB) and profit from a discount!
If you would like to redeem your KAB credit, please log in.
Save over 20% compared to the individual article price.
Article / Publication Details
Received: January 10, 2011
Accepted: February 04, 2011
Published online: March 08, 2011
Issue release date: April 2011
Number of Print Pages: 8
Number of Figures: 1
Number of Tables: 4
ISSN: 0250-8095 (Print)
eISSN: 1421-9670 (Online)
For additional information: https://www.karger.com/AJN
Abstract
Background: Serum free triiodothyronine (fT3) level is suggested to be a risk factor for mortality in unselected dialysis patients. We investigated the prognostic value of serum fT3 levels and also low-T3 syndrome on overall survival in a large cohort of hemodialysis (HD) patients with normal thyroid-stimulating hormone levels. Methods: A total of 669 prevalent HD patients were enrolled in the study. Serum fT3 level was measured by enzyme immune assay in frozen sera samples at the time of enrollment. Overall mortality was assessed during 48 months of follow-up. Results: Baseline fT3 was 1.47 ± 0.43 (0.01–2.98) pg/ml, and low-T3 syndrome was present in 71.7% of the cases. During a mean follow-up of 34 ± 16 months, 165 (24.7%) patients died. fT3 level was a strong predictor for mortality in crude and adjusted Cox models including albumin or high-sensitivity C-reactive protein (hs-CRP). Further adjustment for both albumin and hs-CRP made the impact of fT3 on mortality disappear. The presence of low-T3 syndrome was associated with mortality in only the unadjusted model. Conclusions: Low-T3 syndrome is a frequent finding among HD patients, but it does not predict outcome. However, serum fT3 level is a strong and inverse mortality predictor, in part explained by its underlying association with nutritional state and inflammation.
© 2011 S. Karger AG, Basel
Related Articles:
References
- Iglesias P, Díez JJ: Thyroid dysfunction and kidney disease. Eur J Endocrinol 2009;160:503–515.
- Amato AA, Santos GM, Neves Fde A: Thyroid hormone action in chronic kidney disease. Curr Opin Endocrinol Diabetes Obes 2008;15:459–465.
- Lo JC, Chertow GM, Go AS, Hsu CY: Increased prevalence of subclinical and clinical hypothyroidism in persons with chronic kidney disease. Kidney Int 2005;67:1047–1052.
- Chonchol M, Lippi G, Salvagno G, Zoppini G, Muggeo M, Targher G: Prevalence of subclinical hypothyroidism in patients with chronic kidney disease. Clin J Am Soc Nephrol 2008;3:1296–1300.
- Song SH, Kwak IS, Lee DW, Kang YH, Seong EY, Park JS: The prevalence of low triiodothyronine according to the stage of chronic kidney disease in subjects with a normal thyroid-stimulating hormone. Nephrol Dial Transplant 2009;24:1534–1538.
- Iervasi G, Pingitore A, Landi P, Raciti M, Ripoli A, Scarlattini M, L’Abbate A, Donato L: Low-T3 syndrome: a strong prognostic predictor of death in patients with heart disease. Circulation 2003;107:708–713.
- Iervasi G, Molinaro S, Landi P, Taddei MC, Galli E, Mariani F, L’Abbate A, Pingitore A: Association between increased mortality and mild thyroid dysfunction in cardiac patients. Arch Intern Med 2007;167:1526–1532.
- Zoccali C, Tripepi G, Cutrupi S, Pizzini P, Mallamaci F: Low triiodothyronine: a new facet of inflammation in end-stage renal disease. J Am Soc Nephrol 2005;16:2789–2795.
- Zoccali C, Mallamaci F, Tripepi G, Cutrupi S, Pizzini P: Low triiodothyronine and survival in end-stage renal disease. Kidney Int 2006;70:523–528.
- Enia G, Panuccio V, Cutrupi S, Pizzini P, Tripepi G, Mallamaci F, Zoccali C: Subclinical hypothyroidism is linked to micro-inflammation and predicts death in continuous ambulatory peritoneal dialysis. Nephrol Dial Transplant 2007;22:538–544.
- Zoccali C, Benedetto F, Mallamaci F, Tripepi G, Cutrupi S, Pizzini P, Malatino LS, Bonanno G, Seminara G: Low triiodothyronine and cardiomyopathy in patients with end-stage renal disease. J Hypertens 2006;24:2039–2046.
- Kang EW, Nam JY, Yoo TH, Shin SK, Kang SW, Han DS, Han SH: Clinical implications of subclinical hypothyroidism in continuous ambulatory peritoneal dialysis patients. Am J Nephrol 2008;28:908–913.
- Fernández-Reyes MJ, Diez JJ, Collado A, Iglesias P, Bajo MA, Estrada P, Del Peso G, Heras M, Molina A, Selgas R: Are low concentrations of serum triiodothyronine a good marker for long-term mortality in hemodialysis patients? Clin Nephrol 2010;73:238–240.
- Carrero JJ, Qureshi AR, Axelsson J, Yilmaz MI, Rehnmark S, Witt MR, Bárány P, Heimbürger O, Suliman ME, Alvestrand A, Lindholm B, Stenvinkel P: Clinical and biochemical implications of low thyroid hormone levels (total and free forms) in euthyroid patients with chronic kidney disease. J Intern Med 2007;262:690–702.
- De Groot LJ: Dangerous dogmas in medicine: the nonthyroidal illness syndrome. J Clin Endocrinol Metab 1999;84:151–164.
- Song SH, Kwak IS, Lee DW, Kang YH, Seong EY, Park JS: The prevalence of low triiodothyronine according to the stage of chronic kidney disease in subjects with a normal thyroid-stimulating hormone. Nephrol Dial Transplant 2009;24:1534–1538.
- Díez JJ, Iglesias P, Selgas R: Pituitary dysfunctions in uremic patients undergoing peritoneal dialysis: a cross sectional descriptive study. Adv Perit Dial 1995;11:218–224.
- Wiederkehr MR, Kalogiros J, Krapf R: Correction of metabolic acidosis improves thyroid and growth hormone axes in haemodialysis patients. Nephrol Dial Transplant 2004;19:1190–1197.
- Trivieri MG, Oudit GY, Sah R, Kerfant BG, Sun H, Gramolini AO, Pan Y, Wickenden AD, Croteau W, Morreale de Escobar G, Pekhletski R, St. Germain D, Maclennan DH, Backx PH: Cardiac-specific elevations in thyroid hormone enhance contractility and prevent pressure overload-induced cardiac dysfunction. Proc Natl Acad Sci USA 2006;103:6043–6048.
- Bussemaker E, Popp R, Fisslthaler B, Larson CM, Fleming I, Busse R, Brandes RP: Hyperthyroidism enhances endothelium-dependent relaxation in the rat renal artery. Cardiovasc Res 2003;59:181–188.
- Vanhorebeek I, Langouche L, Van den Berghe G: Endocrine aspects of acute and prolonged critical illness. Nat Clin Pract Endocrinol Metab 2006;2:20–31.
- Torpy DJ, Tsigos C, Lotsikas AJ, Defensor R, Chrousos GP, Papanicolaou DA: Acute and delayed effects of a single-dose injection of interleukin-6 on thyroid function in healthy humans. Metabolism 1998;47:1289–1293.
- Boelen A, Kwakkel J, Wiersinga WM, Fliers E: Chronic local inflammation in mice results in decreased TRH and type 3 deiodinase mRNA expression in the hypothalamic paraventricular nucleus independently of diminished food intake. J Endocrinol 2006;191:707–714.
- de Mutsert R, Grootendorst DC, Axelsson J, Boeschoten EW, Krediet RT, Dekker FW, NECOSAD Study Group: Excess mortality due to interaction between protein-energy wasting, inflammation and cardiovascular disease in chronic dialysis patients. Nephrol Dial Transplant 2008;23:2957–2964.
- Pecoits-Filho R, Lindholm B, Stenvinkel P: The malnutrition, inflammation, and atherosclerosis (MIA) syndrome – the heart of the matter. Nephrol Dial Transplant 2002;17(suppl 11):28–31.
- Carrero JJ, Stenvinkel P: Persistent inflammation as a catalyst for other risk factors in chronic kidney disease: a hypothesis proposal. Clin J Am Soc Nephrol 2009;4(suppl 1):49–55.
- Axelsson J, Qureshi AR, Divino-Filho JC, Bárány P, Heimbürger O, Lindholm B, Stenvinkel P: Are insulin-like growth factor and its binding proteins 1 and 3 clinically useful as markers of malnutrition, sarcopenia and inflammation in end-stage renal disease? Eur J Clin Nutr 2006;60:718–726.
- Chopra IJ: Simultaneous measurement of free thyroxine and free 3,5,3′- triiodothyronine in undiluted serum by direct equilibrium dialysis/radioimmunoassay: evidence that free triiodothyronine and free thyroxine are normal in many patients with the low triiodothyronine syndrome. Thyroid 1998;8:249–257.
Article / Publication Details
Received: January 10, 2011
Accepted: February 04, 2011
Published online: March 08, 2011
Issue release date: April 2011
Number of Print Pages: 8
Number of Figures: 1
Number of Tables: 4
ISSN: 0250-8095 (Print)
eISSN: 1421-9670 (Online)
For additional information: https://www.karger.com/AJN
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
Get Permission
PubMed ID
