Department of Pediatric Nephrology, East Tennessee Children's Hospital, Knoxville, USA.
Department of Medicine, University of Tennessee, Knoxville, USA.
Perit Dial Int. 2024 Jan;44(1):73-77. doi: 10.1177/08968608231183853. Epub 2023 Jul 3.
Children with kidney failure who receive maintenance peritoneal dialysis (PD) are at increased risk for thyroid dysfunction. A poorly appreciated cause of hypothyroidism related to PD is iodine overload from exposure to iodine-containing cleaning solutions, iodinated contrast agents or povidone-iodine-containing PD caps, particularly in infants and small children. An international survey was conducted to understand current practices regarding iodine exposure in PD patients, the frequency of iodine-induced hypothyroidism (IIH) in patients receiving PD, and to assess awareness of this issue among paediatric nephrologists. Eighty-nine paediatric nephrology centres responded to the survey. Hypothyroidism in PD patients was diagnosed in 64% ( = 57) of responding centres, although only 19 of these centres (33%) suspected or diagnosed IIH. Aetiologies of IIH included exposure to povidone-iodine-containing PD caps (53%), cleaning solutions with iodine (37%) and iodinated contrast (10%). While most centres (58%, = 52) routinely evaluate thyroid function, only 34% ( = 30) specifically aim to limit iodine exposure. Of centres not routinely evaluating for or utilising methods to prevent iodine exposure and hypothyroidism, 81% reported being unaware of the risk of IIH in PD patients. Hypothyroidism is diagnosed in a substantial percentage of paediatric PD programmes internationally. Increased education on the risk of iodine exposure in children receiving PD may decrease the incidence of IIH as an aetiology of hypothyroidism.
接受维持性腹膜透析（PD）治疗的肾衰竭儿童发生甲状腺功能障碍的风险增加。PD 相关甲状腺功能减退症的一个不太被重视的原因是碘暴露，其来源于含碘清洁剂、碘造影剂或含聚维酮碘的 PD 帽，尤其是在婴儿和幼儿中。进行了一项国际调查，以了解 PD 患者碘暴露的当前实践、接受 PD 治疗的患者中碘诱导性甲状腺功能减退症（IIH）的频率，以及评估儿科肾病学家对该问题的认识。89 家儿科肾病中心对该调查做出了回应。在作出回应的中心中，有 64%（=57）诊断出 PD 患者存在甲状腺功能减退症，但其中只有 19 家中心（33%）怀疑或诊断出 IIH。IIH 的病因包括使用含聚维酮碘的 PD 帽（53%）、含碘清洁剂（37%）和碘造影剂（10%）。尽管大多数中心（58%，=52）常规评估甲状腺功能，但只有 34%（=30）专门旨在限制碘暴露。在没有常规评估或利用预防碘暴露和甲状腺功能减退症的方法的中心中，81%报告不知道 PD 患者发生 IIH 的风险。国际上相当一部分儿科 PD 计划诊断出了甲状腺功能减退症。增加对接受 PD 治疗的儿童碘暴露风险的教育，可能会降低 IIH 作为甲状腺功能减退症病因的发生率。
