Preservation of renal function by thyroid hormone replacement therapy in chronic kidney disease patients with subclinical hypothyroidism

Dong Ho Shin; Mi Jung Lee; Seung Jun Kim; Hyung Jung Oh; Hyoung Rae Kim; Jae Hyun Han; Hyang Mo Koo; Fa Mee Doh; Jung Tak Park; Seung Hyeok Han; Tae-Hyun Yoo; Shin-Wook Kang

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Preservation of renal function by thyroid hormone replacement therapy in chronic kidney disease patients with subclinical hypothyroidism

Authors: Dong Ho Shin ; Mi Jung Lee ; Seung Jun Kim ; Hyung Jung Oh ; Hyoung Rae Kim ; Jae Hyun Han ; Hyang Mo Koo ; Fa Mee Doh ; Jung Tak Park ; Seung Hyeok Han ; Tae-Hyun Yoo ; Shin-Wook Kang

Citation: JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, Vol.97(8) : 2732-2740, 2012

Journal Title: JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM

ISSN: 0021-972X

Issue Date: 2012

MeSH: Adult ; Aged ; Blood Pressure ; Chronic Disease ; Female ; Glomerular Filtration Rate ; Hormone Replacement Therapy* ; Humans ; Hypothyroidism/drug therapy* ; Hypothyroidism/physiopathology ; Iodide Peroxidase/immunology ; Kidney Diseases/complications* ; Kidney Diseases/physiopathology ; Male ; Middle Aged ; Thyroid Hormones/therapeutic use* ; Thyrotropin/blood

Keywords: Adult ; Aged ; Blood Pressure ; Chronic Disease ; Female ; Glomerular Filtration Rate ; Hormone Replacement Therapy* ; Humans ; Hypothyroidism/drug therapy* ; Hypothyroidism/physiopathology ; Iodide Peroxidase/immunology ; Kidney Diseases/complications* ; Kidney Diseases/physiopathology ; Male ; Middle Aged ; Thyroid Hormones/therapeutic use* ; Thyrotropin/blood

Abstract: CONTEXT: Subclinical hypothyroidism is not a rare condition, but the use of thyroid hormone to treat subclinical hypothyroidism is an issue of debate.

OBJECTIVE: This study was undertaken to investigate the impact of thyroid hormone therapy on the changes in estimated glomerular filtration rate (eGFR) in subclinical hypothyroidism patients with stage 2-4 chronic kidney disease.

PATIENTS: A total of 309 patients were included in the final analysis.

MAIN OUTCOME MEASURE: The changes in eGFR over time were compared between patients with and without thyroid hormone replacement therapy using a linear mixed model. Kaplan-Meier curves were constructed to determine the effect of thyroid hormone on renal outcome, a reduction of eGFR by 50%, or end-stage renal disease. The independent prognostic value of subclinical hypothyroidism treatment for renal outcome was ascertained by multivariate Cox regression analysis.

RESULTS: Among the 309 patients, 180 (58.3%) took thyroid hormone (treatment group), whereas 129 (41.7%) did not (nontreatment group). During the mean follow-up duration of 34.8 ± 24.3 months, the overall rate of decline in eGFR was significantly greater in the nontreatment group compared to the treatment group (-5.93 ± 1.65 vs. -2.11 ± 1.12 ml/min/yr/1.73 m(2); P = 0.04). Moreover, a linear mixed model revealed that there was a significant difference in the rates of eGFR decline over time between the two groups (P < 0.01). Kaplan-Meier analysis also showed that renal event-free survival was significantly lower in the nontreatment group (P < 0.01). In multivariate Cox regression analysis, thyroid hormone replacement therapy was found to be an independent predictor of renal outcome (hazard ratio, 0.28; 95% CI, 0.12-0.68; P = 0.01).

CONCLUSION: Thyroid hormone therapy not only preserved renal function better, but was also an independent predictor of renal outcome in chronic kidney disease patients with subclinical hypothyroidism.