美国退伍军人亚临床甲状腺功能减退症合并慢性肾脏病患者左甲状腺素对肾功能的影响：一项回顾性观察性队列研究。

Effect of Levothyroxine on Kidney Function in Chronic Kidney Disease with Subclinical Hypothyroidism in US Veterans: A Retrospective Observational Cohort Study.

机构信息

Division of Endocrinology, Beth Israel Deaconess Medical Center, Boston, MA, USA.

Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.

出版信息

Adv Ther. 2021 Feb;38(2):1185-1201. doi: 10.1007/s12325-020-01589-3. Epub 2020 Dec 23.

DOI:10.1007/s12325-020-01589-3

PMID:33355908

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7889570/

Abstract

INTRODUCTION

Chronic kidney disease (CKD) may be associated with overt or subclinical hypothyroidism [SCH; defined as elevated serum thyroid-stimulating hormone (TSH) despite normal free thyroxine levels). Although some studies have demonstrated that thyroid replacement therapy may improve renal function in overt hypothyroidism, there is no consensus on its benefits in SCH. Clinical and limited economic outcomes were evaluated in levothyroxine-treated US veterans with CKD + SCH.

METHODS

Veterans Health Administration claims data from April 2013 to March 2018 for levothyroxine-treated versus nontreated CKD + SCH patients were compared. Eligible patients with CKD + SCH (≥ 2 elevated TSH values recorded; ≥ 2 normal thyroxine values recorded) had ≥ 1 TSH values recorded during 24-month follow-up, and ≥ 1 estimated glomerular filtration rate (eGFR) measurement during baseline and follow-up. Continuous levothyroxine use (treatment cohort) was required during follow-up. The primary endpoint was eGFR at 6, 12, 18, and 24 months; secondary endpoints included eGFR change from baseline, CKD progression, and length of hospital stay (LOS). Propensity score matching (PSM) was performed.

RESULTS

Of 453 eligible patients, 157 remained in each cohort after PSM. Most were male (96%) and white (88%); mean age was 75 years. No significant differences were observed between cohorts at any time point for eGFR, eGFR change from baseline, or CKD progression. Treated patients had numerically higher mean eGFR at 6 and 12 months, lower proportions of progression to higher CKD stages at 12, 18, and 24 months, and shorter mean all-cause LOS versus nontreated patients (1.92 vs. 3.30 days; P = 0.3483) within the 24-month follow-up period. A significantly shorter mean CKD-related LOS was observed versus nontreated patients (0.11 vs. 1.38 days; P < 0.0001) during the 24-month follow-up.

CONCLUSION

Levothyroxine use was associated with economic and clinical benefit in some patients with CKD + SCH, despite an absence of overall benefit on eGFR; confirmatory research is needed.

摘要

简介

慢性肾脏病（CKD）可能与显性或亚临床甲状腺功能减退症（SCH；定义为血清促甲状腺激素（TSH）升高，尽管游离甲状腺素水平正常）有关。尽管一些研究表明甲状腺替代疗法可能改善显性甲状腺功能减退症患者的肾功能，但对于 SCH 是否有益尚无共识。评估了接受左甲状腺素治疗的美国退伍军人中 CKD+SCH 的临床和有限的经济结局。

方法

比较了 2013 年 4 月至 2018 年 3 月期间接受左甲状腺素治疗与未接受治疗的 CKD+SCH 患者的退伍军人健康管理局（Veterans Health Administration）索赔数据。有≥2 次记录的升高 TSH 值和≥2 次记录的正常甲状腺素值的 CKD+SCH 合格患者（记录了≥24 个月的 TSH 值，并且在基线和随访期间至少有 1 次记录了估计肾小球滤过率（eGFR）值），在随访期间需要持续使用左甲状腺素（治疗组）。主要终点是 6、12、18 和 24 个月时的 eGFR；次要终点包括从基线开始的 eGFR 变化、CKD 进展和住院时间（LOS）。进行了倾向评分匹配（PSM）。

结果

在 453 名合格患者中，匹配后每组有 157 名患者。大多数患者为男性（96%）和白人（88%）；平均年龄为 75 岁。在任何时间点，治疗组和未治疗组的 eGFR、从基线开始的 eGFR 变化或 CKD 进展都没有显著差异。与未治疗组相比，治疗组在 6 个月和 12 个月时的平均 eGFR 更高，在 12、18 和 24 个月时进展到更高 CKD 阶段的比例更低，在 24 个月的随访期间平均全因 LOS 更短（1.92 天与 3.30 天；P=0.3483）。与未治疗组相比，在 24 个月的随访期间，治疗组的 CKD 相关 LOS 明显更短（0.11 天与 1.38 天；P<0.0001）。