Department of Internal Medicine III; Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria.
Department of Pharmacology and Toxicology, University of Vienna, Vienna, Austria.
Sci Rep. 2020 Feb 7;10(1):2156. doi: 10.1038/s41598-020-59178-x.
Elevated levels of thyroid-stimulating-hormone (TSH) are associated with reduced glomerular filtration rate (GFR) and increased risk of developing chronic kidney disease even in euthyroid patients. Thyroid hormone replacement therapy has been shown to delay progression to end-stage renal disease in sub-clinically hypothyroid patients with renal insufficiency. However, such associations after kidney transplantation were never investigated. In this study the association of thyroid hormones and estimated GFR (eGFR) in euthyroid patients after kidney transplantation was analyzed. In total 398 kidney transplant recipients were assessed retrospectively and association between thyroid and kidney function parameters at and between defined time points, 12 and 24 months after transplantation, was studied. A significant inverse association was shown for TSH changes and eGFR over time between months 12 and 24 post transplantation. For each increase of TSH by 1 µIU/mL, eGFR decreased by 1.34 mL/min [95% CI, -2.51 to -0.16; p = 0.03], corresponding to 2.2% eGFR decline, within 12 months. At selected time points 12 and 24 months post transplantation, however, TSH was not associated with eGFR. In conclusion, an increase in TSH between 12 and 24 months after kidney transplantation leads to a significant decrease in eGFR, which strengthens the concept of a kidney-thyroid-axis.
促甲状腺激素（TSH）水平升高与肾小球滤过率（GFR）降低和发展为慢性肾脏病的风险增加相关，即使在甲状腺功能正常的患者中也是如此。研究表明，甲状腺激素替代疗法可延迟亚临床甲状腺功能减退伴肾功能不全患者进展为终末期肾病。然而，从未研究过肾移植后这些相关性。在这项研究中，分析了甲状腺激素与肾移植后甲状腺功能正常患者的估计肾小球滤过率（eGFR）之间的关系。共回顾性评估了 398 例肾移植受者，并研究了移植后 12 个月和 24 个月时甲状腺和肾功能参数之间的关联。结果显示，移植后 12 个月至 24 个月期间，TSH 变化与 eGFR 呈显著负相关。TSH 每增加 1µIU/mL，eGFR 在 12 个月内下降 1.34mL/min[95%CI,-2.51 至-0.16;p=0.03]，对应于 eGFR 下降 2.2%。然而，在移植后 12 个月和 24 个月的选定时间点，TSH 与 eGFR 无关。总之，肾移植后 12 至 24 个月之间 TSH 的增加会导致 eGFR 显著下降，这加强了肾脏-甲状腺轴的概念。
