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Thyroid hormone replacement therapy attenuates the decline of renal function in chronic kidney disease patients with subclinical hypothyroidism

Authors
 Dong Ho Shin  ;  Mi Jung Lee  ;  Hye Sun Lee  ;  Hyung Jung Oh  ;  Kwang Il Ko  ;  Chan Ho Kim  ;  Fa Mee Doh  ;  Hyang Mo Koo  ;  Hyoung Rae Kim  ;  Jae Hyun Han  ;  Jung Tak Park  ;  Seung Hyeok Han  ;  Tae-Hyun Yoo  ;  Shin-Wook Kang 
Citation
 THYROID, Vol.23(6) : 654-661, 2013 
Journal Title
 THYROID 
ISSN
 1050-7256 
Issue Date
2013
MeSH
Aged ; Disease Progression ; Down-Regulation/drug effects ; Female ; Follow-Up Studies ; Glomerular Filtration Rate/drug effects ; Hormone Replacement Therapy* ; Humans ; Hypothyroidism/blood ; Hypothyroidism/complications ; Hypothyroidism/drug therapy* ; Hypothyroidism/physiopathology ; Kidney/drug effects* ; Kidney/physiopathology ; Kidney Failure, Chronic/etiology ; Kidney Failure, Chronic/prevention & control ; Linear Models ; Male ; Medical Records ; Middle Aged ; Renal Insufficiency, Chronic/blood ; Renal Insufficiency, Chronic/complications ; Renal Insufficiency, Chronic/drug therapy* ; Renal Insufficiency, Chronic/physiopathology ; Retrospective Studies ; Severity of Illness Index ; Thyrotropin/blood ; Thyroxine/therapeutic use*
Keywords
Aged ; Disease Progression ; Down-Regulation/drug effects ; Female ; Follow-Up Studies ; Glomerular Filtration Rate/drug effects ; Hormone Replacement Therapy* ; Humans ; Hypothyroidism/blood ; Hypothyroidism/complications ; Hypothyroidism/drug therapy* ; Hypothyroidism/physiopathology ; Kidney/drug effects* ; Kidney/physiopathology ; Kidney Failure, Chronic/etiology ; Kidney Failure, Chronic/prevention & control ; Linear Models ; Male ; Medical Records ; Middle Aged ; Renal Insufficiency, Chronic/blood ; Renal Insufficiency, Chronic/complications ; Renal Insufficiency, Chronic/drug therapy* ; Renal Insufficiency, Chronic/physiopathology ; Retrospective Studies ; Severity of Illness Index ; Thyrotropin/blood ; Thyroxine/therapeutic use*
Abstract
Background: Subclinical hypothyroidism (SCH) is not a rare condition in females, the elderly, or patients with chronic kidney disease (CKD). Even though previous studies have demonstrated that thyroid hormone replacement therapy (THRT) improves cardiac function and dyslipidemia in patients with SCH, it remains unclear as to whether THRT can improve renal function in CKD patients with SCH. This study investigated the impact of THRT on changes in estimated glomerular filtration rates (eGFR) in this patient population. Methods: A total of 113 CKD patients with SCH who were treated with L-thyroxine and had eGFR available for at least 24 months before and after THRT were enrolled between January 2005 and December 2011. A linear mixed model was used to compare patients' clinical and biochemical parameters at various time points. The slope of the decline in eGFR over time, both before and after THRT, was also calculated and compared using a linear mixed model. Results: The mean age of the study participants was 63.2±12.7 years, and 36 patients (31.9%) were men. The mean follow-up duration before and after THRT was 28.6±4.5 and 30.6±6.4 months respectively. After 24 months of THRT, serum thyrotropin (TSH) levels were significantly reduced—8.86±0.49 versus 1.41±0.73 μIU/mL, p<0.001—but there were no significant changes in triiodothyronine and free thyroxine concentrations. Serum albumin, calcium, phosphate, cholesterol, and triglyceride levels were also comparable before and after THRT. The rates of decline in eGFR were significantly attenuated by THRT (−4.31±0.51 vs.−1.08±0.36 [mL/min]/[year·1.73 m2], p<0.001), even after adjustment for age, sex, diabetes, mean arterial pressure, and serum albumin, cholesterol, and triglyceride concentrations (p<0.001). Conclusion: THRT attenuated the rate of decline in renal function in CKD patients with SCH, suggesting that THRT may delay reaching end-stage renal disease in these patients.
Full Text
http://online.liebertpub.com/doi/abs/10.1089/thy.2012.0475
DOI
10.1089/thy.2012.0475
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
Yonsei Authors
Kang, Shin Wook(강신욱) ORCID logo https://orcid.org/0000-0002-5677-4756
Ko, Kwang Il(고광일)
Koo, Hyang Mo(구향모)
Kim, Chan Ho(김찬호)
Kim, Hyoung Rae(김형래)
Doh, Fa Mee(도화미) ORCID logo https://orcid.org/0000-0002-4780-6728
Park, Jung Tak(박정탁) ORCID logo https://orcid.org/0000-0002-2325-8982
Oh, Hyung Jung(오형중)
Yoo, Tae Hyun(유태현) ORCID logo https://orcid.org/0000-0002-9183-4507
Lee, Mi Jung(이미정)
Lee, Hye Sun(이혜선) ORCID logo https://orcid.org/0000-0001-6328-6948
Han, Seung Hyeok(한승혁) ORCID logo https://orcid.org/0000-0001-7923-5635
Han, Jae Hyun(한재현)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/87195
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