Cheng Yuan, Hu Haofei, Li Wangyang, Nie Sheng, Zhou Shiyu, Chen Yuna, Cao Tao, Xu Hong, Liu Bicheng, Chen Chunbo, Liu Huafeng, Yang Qiongqiong, Li Hua, Kong Yaozhong, Li Guisen, Zha Yan, Hu Ying, Xu Gang, Shi Yongjun, Zhou Yilun, Su Guobin, Tang Ying, Gong Mengchun, Wan Qijun
Department of Nephrology, The Second People's Hospital of Shenzhen, The First Affiliated Hospital of Shenzhen University, Shenzhen 518000, China.
Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
J Clin Endocrinol Metab. 2025 Jul 15;110(8):e2446-e2455. doi: 10.1210/clinem/dgae841.
Thyroid dysfunction is prevalent in chronic kidney disease (CKD) patients and significantly impacts renal outcomes and mortality.
This study investigated the associations between thyroid function and clinical outcomes, and also the therapeutic effects of thyroid hormone replacement therapy (THRT) in CKD patients.
We conducted a retrospective cohort study using data from the China Renal Data System. The primary endpoints were composite renal failure and all-cause mortality. The secondary endpoint was the impact of THRT on renal outcomes. Associations were analyzed using multivariable Cox proportional hazards regression models and Kaplan-Meier survival analyses, with adjustment for relevant clinical and demographic covariates.
Among 30 804 CKD patients enrolled, 26 673 (86.6%) had normal thyroid function, 2291 (7.4%) had hypothyroidism, and 1840 (6.0%) had hyperthyroidism. Hypothyroidism independently predicted increased risk of renal failure (adjusted HR = 1.29; 95% CI, 1.15-1.45; P < .001). Both hypothyroidism (adjusted HR = 1.24; 95% CI, 1.11-1.39; P < .001) and hyperthyroidism (adjusted HR = 1.20; 95% CI, 1.07-1.33; P < .01) were associated with increased all-cause mortality. Notably, THRT was associated with significantly reduced risk of renal failure (adjusted HR = 0.65; 95% CI, 0.52-0.82; P < .001) in hypothyroid patients.
This large-scale cohort study demonstrates that hypothyroidism accelerates CKD progression, while both hypo- and hyperthyroidism increase mortality risk in CKD patients. THRT appears to attenuate the adverse effects of hypothyroidism on renal function. Regular thyroid function monitoring and appropriate THRT should be considered in CKD management.
甲状腺功能障碍在慢性肾脏病（CKD）患者中普遍存在，并对肾脏结局和死亡率有显著影响。
本研究调查了甲状腺功能与临床结局之间的关联，以及甲状腺激素替代疗法（THRT）对CKD患者的治疗效果。
我们使用中国肾脏数据系统的数据进行了一项回顾性队列研究。主要终点是复合肾衰竭和全因死亡率。次要终点是THRT对肾脏结局的影响。使用多变量Cox比例风险回归模型和Kaplan-Meier生存分析对关联进行分析，并对相关临床和人口统计学协变量进行调整。
在纳入的30804例CKD患者中，26673例（86.6%）甲状腺功能正常，2291例（7.4%）患有甲状腺功能减退症，1840例（6.0%）患有甲状腺功能亢进症。甲状腺功能减退症独立预测肾衰竭风险增加（调整后HR = 1.29；95%CI，1.15 - 1.45；P <.001）。甲状腺功能减退症（调整后HR = 1.24；95%CI，1.11 - 1.39；P <.001）和甲状腺功能亢进症（调整后HR = 1.20；95%CI，1.07 - 1.33；P <.01）均与全因死亡率增加相关。值得注意的是，在甲状腺功能减退症患者中，THRT与肾衰竭风险显著降低相关（调整后HR = 0.65；95%CI，0.52 - 0.82；P <.001）。
这项大规模队列研究表明，甲状腺功能减退症会加速CKD进展，而甲状腺功能减退症和甲状腺功能亢进症均会增加CKD患者的死亡风险。THRT似乎可减轻甲状腺功能减退症对肾功能的不良影响。在CKD管理中应考虑定期监测甲状腺功能并进行适当的THRT。
