Rhee Connie M, Kim Steven, Gillen Daniel L, Oztan Tolga, Wang Jiaxi, Mehrotra Rajnish, Kuttykrishnan Sooraj, Nguyen Danh V, Brunelli Steven M, Kovesdy Csaba P, Brent Gregory A, Kalantar-Zadeh Kamyar
Harold Simmons Center for Chronic Disease Research and Epidemiology (C.M.R., K.K.-Z.), Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, California 92868; Los Angeles Biomedical Research Institute (C.M.R., K.K.-Z.), Harbor-UCLA Medical Center Torrance, California 90502; Department of Statistics (S.K., D.L.G., T.O., J.W.), University of California Irvine School of Medicine, Irvine, California 92697; Division of Nephrology (R.M., S.K.), Harborview Medical Center, University of Washington, Seattle, Washington 98104; Division of General Internal Medicine (D.V.N.), University of California Irvine Medical Center, Orange, California 92868; DaVita Clinical Research (S.M.B.), Minneapolis, Minnesota 55404; Nephrology Section (C.P.K.), Memphis Veterans Affairs Medical Center, Memphis, Tennessee 38104; Division of Nephrology (C.P.K.), University of Tennessee Health Science Center, Memphis, Tennessee 38163; and Division of Endocrinology (G.A.B.), University of California Los Angeles, Los Angeles, California 90095.
J Clin Endocrinol Metab. 2015 Apr;100(4):1386-95. doi: 10.1210/jc.2014-4311. Epub 2015 Jan 29.
Hypothyroidism is a common condition that disproportionately affects hemodialysis patients. In the general population, hypothyroidism is associated with higher mortality, particularly in populations with underlying cardiovascular risk. Despite their heightened cardiovascular mortality, the impact of hypothyroidism on the survival of hemodialysis patients remains uncertain.
To examine whether hypothyroidism is independently associated with higher mortality in hemodialysis patients.
DESIGN, SETTING, AND PATIENTS: Among 8840 incident hemodialysis patients receiving care from a large national dialysis provider from January 2007 to December 2011, we examined the association of hypothyroidism (TSH >5.0 mIU/L) with mortality.
Associations between baseline and time-dependent hypothyroidism with all-cause mortality were determined using case-mix adjusted Cox models. In secondary analyses, we examined the impact of low-normal, upper-normal, subclinical range, and overt range TSH levels (TSH ≥ 0.5-3.0, >3.0-5.0, >5.0-10.0, and >10.0 mIU/L, respectively) on mortality risk.
The study population consisted of 1928 (22%) hypothyroid and 6912 (78%) euthyroid patients. Baseline and time-dependent hypothyroidism were associated with higher mortality: adjusted hazard ratios (95% confidence intervals) were 1.47 (1.34-1.61) and 1.62 (1.45-1.80), respectively. Compared to low-normal TSH, upper-normal, subclinical hypothyroid, and overt hypothyroid TSH levels were associated with incrementally higher adjusted death risk in baseline and time-dependent analyses. In time-dependent analyses, the hypothyroidism-mortality association was increasingly stronger across higher body mass index strata.
Hypothyroidism as well as upper-normal TSH levels are associated with higher mortality in hemodialysis patients. Further studies are needed to determine whether restoration of TSH to low-normal levels with thyroid hormone replacement therapy ameliorates adverse outcomes in hemodialysis patients.
甲状腺功能减退是一种常见病症，对血液透析患者的影响尤为严重。在普通人群中，甲状腺功能减退与较高的死亡率相关，尤其是在有潜在心血管风险的人群中。尽管血液透析患者的心血管死亡率较高，但甲状腺功能减退对其生存的影响仍不确定。
研究甲状腺功能减退是否与血液透析患者的较高死亡率独立相关。
设计、地点和患者：在2007年1月至2011年12月期间接受一家大型全国性透析服务提供商治疗的8840例新接受血液透析的患者中，我们研究了甲状腺功能减退（促甲状腺激素>5.0 mIU/L）与死亡率之间的关联。
使用病例组合调整的Cox模型确定基线和随时间变化的甲状腺功能减退与全因死亡率之间的关联。在二次分析中，我们研究了低正常、高正常、亚临床范围和显性范围的促甲状腺激素水平（分别为促甲状腺激素≥0.5 - 3.0、>3.0 - 5.0、>5.0 - 10.0和>10.0 mIU/L）对死亡风险的影响。
研究人群包括1928例（22%）甲状腺功能减退患者和6912例（78%）甲状腺功能正常患者。基线和随时间变化的甲状腺功能减退与较高死亡率相关：调整后的风险比（95%置信区间）分别为1.47（1.34 - 1.61）和1.62（1.45 - 1.80）。与低正常促甲状腺激素水平相比，高正常、亚临床甲状腺功能减退和显性甲状腺功能减退的促甲状腺激素水平在基线和随时间变化的分析中与调整后的死亡风险逐步增加相关。在随时间变化的分析中，甲状腺功能减退与死亡率的关联在较高体重指数分层中越来越强。
甲状腺功能减退以及高正常促甲状腺激素水平与血液透析患者的较高死亡率相关。需要进一步研究以确定通过甲状腺激素替代疗法将促甲状腺激素恢复到低正常水平是否能改善血液透析患者的不良结局。
