We investigated dialysis duration, dose of erythropoietin (EPO), and clinical manifestations in peritoneal dialysis (PD) patients with subclinical hypothyroidism.
Methods
This cross-sectional study, performed in 3 centers, assessed 122 adult patients on PD for more than 6 months with regard to demographic data, dialysis duration, thyroid function, biochemical data, EPO dose, and clinical manifestations. Thyroid dysfunction was determined by serum thyroid-stimulating hormone, free thyroxine, total thyroxine, total triiodothyronine, antithyroid peroxidase antibodies, and auto-antibodies against thyroglobulin.
Results
Of the 122 study patients, 98 (80.3%) were assessed as having euthyroidism; 19 (15.6%), subclinical hypothyroidism; and 5 (4.1%), subclinical hyperthyroidism. The proportion of women (74.2% vs. 57.1%, p = 0.038), the mean duration of PD (58.1 months vs. 37.9 months, p = 0.032), and the weighted mean monthly EPO dose (1.22 μg/kg vs. 1.64 μg/kg, p = 0.009) were significantly higher in the subclinical hypothyroidism group than in the euthyroidism group, but the prevalences of coronary artery disease and cerebrovascular disease were not. From the multivariate model, PD duration was more significant than sex as a risk factor for subclinical hypothyroidism (p = 0.0132).
Conclusions
Subclinical hypothyroidism is frequent in PD patients, especially female patients and patients with a longer PD duration. Compared with euthyroid patients, patients with subclinical hyperthyroidism need a higher dose of EPO to maintain a stable hemoglobin level.
HollowellJ.G., StaehlingN.W., FlandersW.D., HannonW.H., GunterE.W., SpencerC.A.Serum TSH, T4, and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III).J Clin Endocrinol Metab2002; 87: 489–99.
3.
VanderpumpM.P., TunbridgeW.M., FrenchJ.M., AppletonD., BatesD., ClarkF.The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey.Clin Endocrinol (Oxf)1995; 43: 55–68.
4.
ChuangC.C., WangS.T., WangP.W., YuM.L.Prevalence study of thyroid dysfunction in the elderly of Taiwan.Gerontology1998; 44: 162–7.
5.
LimV.S.Thyroid function in patients with chronic renal failure.Am J Kidney Dis2001; 38(Suppl 1): S80–4.
6.
LinC.C., ChenT.W., NgY.Y., ChouY.H., YangW.C.Thyroid dysfunction and nodular goiter in hemodialysis and peritoneal dialysis patients.Perit Dial Int1998; 18: 516–21.
7.
KapteinE.M.Thyroid hormone metabolism and thyroid diseases in chronic renal failure.Endocr Rev1996; 17: 45–63.
SanaiT., InoueT., OkamuraK., SatoK., YamamotoK., AbeT.Reversible primary hypothyroidism in Japanese patients undergoing maintenance hemodialysis.Clin Nephrol2008; 69: 107–13.
13.
WiederkehrM.R., KalogirosJ., KrapfR.Correction of metabolic acidosis improves thyroid and growth hormone axes in haemodialysis patients.Nephrol Dial Transplant2004; 19: 1190–7.
14.
BandoY., UshiogiY., OkafujiK., ToyaD., TanakaN., MiuraS.Non-autoimmune primary hypothyroidism in diabetic and non-diabetic chronic renal dysfunction.Exp Clin Endocrinol Diabetes2002; 110: 408–15.
15.
KonnoN., MakitaH., YuriK., IizukaN., KawasakiK.Association between dietary iodine intake and prevalence of subclinical hypothyroidism in the coastal regions of Japan.J Clin Endocrinol Metab1994; 78: 393–7.
16.
RobeyC., ShreedharK., BatumanV.Effects of chronic peritoneal dialysis on thyroid function tests.Am J Kidney Dis1989; 13: 99–103.
17.
GardnerD.F., MarsD.R., ThomasR.G., BumrungsupC., MisbinR.I.Iodine retention and thyroid dysfunction in patients on hemodialysis and continuous ambulatory peritoneal dialysis.Am J Kidney Dis1986; 7: 471–6.
18.
ImaizumiM., AkahoshiM., IchimaruS., NakashimaE., HidaA., SodaM.Risk for ischemic heart disease and all-cause mortality in subclinical hypothyroidism.J Clin Endocrinol Metab2004; 89: 3365–70.
19.
MonzaniF., Di BelloV., CaraccioN., BertiniA., GiorgiD., GiustiC.Effect of levothyroxine on cardiac function and structure in subclinical hypothyroidism: a double blind, placebo-controlled study.J Clin Endocrinol Metab2001; 86: 1110–15.
20.
WalshJ.P., BremnerA.P., BulsaraM.K., O'LearyP., LeedmanP.J., FeddemaP.Subclinical thyroid dysfunction as a risk factor for cardiovascular disease.Arch Intern Med2005; 165: 2467–72.
21.
OchsN., AuerR., BauerD.C., NanchenD., GusseklooJ., CornuzJ.Meta-analysis: subclinical thyroid dysfunction and the risk for coronary heart disease and mortality.Ann Intern Med2008; 148: 832–45.
Karakurum GokselB., KaratasM., NebiogluA., SezginN., TanM., SeydaogluG.Subclinical hypothyroidism, hyperhomocysteinemia and dyslipidemia: investigating links with ischemic stroke in Turkish patients.Neurol res2007; 29: 871–6.
24.
Special report from the National Institute of Neurological Disorders and Stroke. Classification of cerebrovascular diseases III.Stroke1990; 21: 637–76.
Koren-MoragN., GoldbourtU., TanneD.Renal dysfunction and risk of ischemic stroke or TIA in patients with cardiovascular disease.Neurology2006; 67: 224–8.
27.
ToyodaK., FujiiK., AndoT., KumaiY., IbayashiS., IidaM.Incidence, etiology, and outcome of stroke in patients on continuous ambulatory peritoneal dialysis.Cerebrovasc Dis2004; 17: 98–105.
28.
Patient mortality and survival. United States Renal Data System.Am J Kidney Dis1998; 32(Suppl 1): S69–80.
29.
FoleyR.N., ParfreyP.S., SarnakM.J.Epidemiology of cardiovascular disease in chronic renal disease.J Am Soc Nephrol1998; 9(Suppl): S16–23.
30.
KangE.W., NamJ.Y., YooT.H., ShinS.K., KangS.W., HanD.S.Clinical implications of subclinical hypothyroidism in continuous ambulatory peritoneal dialysis patients.Am J Nephrol2008; 28: 908–13.
31.
KasagiK., TakahashiN., InoueG., HondaT., KawachiY., IzumiY.Thyroid function in Japanese adults as assessed by a general health checkup system in relation with thyroid-related antibodies and other clinical parameters.Thyroid2009; 19: 937–44.
32.
SurksM.I., OrtizE., DanielsG.H., SawinC.T., ColN.F., CobinR.H.Subclinical thyroid disease: scientific review and guidelines for diagnosis and management.JAMA2004; 291: 228–38.
33.
LoJ.C., ChertowG.M., GoA.S., HsuC.Y.Increased prevalence of subclinical and clinical hypothyroidism in persons with chronic kidney disease.Kidney Int2005; 67: 1047–52.
34.
Descamps-LatschaB., HerbelinA., NguyenA.T., ZingraffJ., JungersP., ChatenoudL.Immune system dysregulation in uremia.Semin Nephrol1994; 14: 253–60.
35.
GirndtM.Humoral immune responses in uremia and the role of IL-10.Blood Purif2002; 20: 485–8.
36.
SezerS., OzdemirF.N., GuzG., AratZ., ColakT., SengulS.Factors influencing response to hepatitis B virus vaccination in hemodialysis patients.Transplant Proc2000; 32: 607–8.
37.
GirndtM., SesterM., SesterU., KaulH., KohlerH.Molecular aspects of T- and B-cell function in uremia.Kidney Int Suppl2001; 78: S206–11.
38.
ChangP.M., NgY.Y.Amiodarone-induced hypothyroidism with EPO-resistant anemia in a patient with chronic renal failure.J Chin Med Assoc2008; 71: 576–8.
39.
DilekM., AkpolatT., CengizK.Hypothyroidism as a cause of resistance to erythropoietin.Nephron2002; 92: 248.
40.
SungurC., ErbasT., AkpolatT., ArikN., YasavulU., TurganC.Resistance to human recombinant erythropoietin in hypothyroidism.Acta Haematol1992; 88: 162.
41.
DorrM., EmpenK., RobinsonD.M., WallaschofskiH., FelixS.B., VolzkeH.The association of thyroid function with carotid artery plaque burden and strokes in a population-based sample from a previously iodine-deficient area.Eur J Endocrinol2008; 159: 145–52.
42.
RodondiN., NewmanA.B., VittinghoffE., de RekeneireN., SatterfieldS., HarrisT.B.Subclinical hypothyroidism and the risk of heart failure, other cardiovascular events, and death.Arch Intern Med2005; 165: 2460–6.
43.
BaekJ.H., ChungP.W., KimY.B., MoonH.S., SuhB.C., JinD.K.Favorable influence of subclinical hypothyroidism on the functional outcomes in stroke patients.Endocr J2010; 57: 23–9.
44.
SimonsickE.M., NewmanA.B., FerrucciL., SatterfieldS., HarrisT.B., RodondiN.Subclinical hypothyroidism and functional mobility in older adults.Arch Intern Med2009; 169: 2011–17.
