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Thyroid function and cardiovascular events in chronic kidney disease patients

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Abstract

Background and aims

Abnormalities of thyroid function are commonly seen in chronic kidney disease (CKD) patients. They are associated with adverse clinical conditions such as atherosclerosis, endothelial dysfunction, inflammation and abnormal blood pressure variability. We investigated the association between thyroid disorders and endothelial function, assessed by flow-mediated dilatation (FMD) and carotid intima-media thickness (CIMT), and cardiovascular events (CVE) in CKD patients.

Materials and methods

This observational cohort study included 305 CKD (stages 1–5) patients. Routine biochemistry, including free T3, free T4 and thyroid stimulating hormone, fibroblast growth factor-23 (FGF-23) and FMD, CIMT were measured. We divided patients into four groups according to thyroid hormone status: euthyroidism, subclinical hyperthyroidism, subclinical hypothyroidism, and euthyroid sick syndrome. Fatal and composite CVE were recorded for a median 29 months.

Results

Patients with subclinical hypothyroidism had a higher prevalence of hypertension and diabetes and also were more likely to have higher values of systolic CIMT, phosphorus, intact parathormone (iPTH), FGF-23, homeostasis model assessment-insulin resistance and lower levels of FMD than euthyroid patients. In the unadjusted survival analysis, subclinical hypothyroidism and euthyroid sick syndrome were associated with an increased risk for the outcome as compared with euthyroidism [hazard ratio 30.63 (95 % confidence interval 12.27–76.48) and 12.17 (3.70–39.98), respectively]. The effects of subclinical hypothyroidism and euthyroid sick syndrome were maintained even in fully adjusted models.

Conclusion

We demonstrated that subclinical hypothyroidism and euthyroid sick syndrome are associated with increased CVE in CKD patients. Further studies are needed to explore these issues.

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Authors and Affiliations

  1. Department of Nephrology, Konya Numune State Hospital, Konya, Turkey

    Baris Afsar

  2. Department of Nephrology, Gulhane School of Medicine, Ankara, Turkey

    Mahmut Ilker Yilmaz, Hilmi Umut Unal, Murat Karaman, Mustafa Gezer, Tayfun Eyileten, Yusuf Oguz & Mehmet Kanbay

  3. Nephrology Clinic, Dialysis and Renal Transplant Center, ‘C.I. PARHON’ University Hospital, ‘Grigore T. Popa’ University of Medicine, Iasi, Romania

    Dimitrie Siriopol & Adrian Covic

  4. Department of Radiology, Gulhane School of Medicine, Ankara, Turkey

    Mutlu Saglam

  5. Department of Endocrinology, Gulhane School of Medicine, Ankara, Turkey

    Alper Sonmez & Ibrahim Aydin

  6. Department of Biochemistry, Gulhane School of Medicine, Ankara, Turkey

    Salih Hamcan

  7. Department of Medicine, Division of Nephrology, Koc University School of Medicine, Topkapı, 03490, Istanbul, Turkey

    Mehmet Kanbay

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  1. Baris Afsar
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  2. Mahmut Ilker Yilmaz
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Corresponding author

Correspondence to Mehmet Kanbay.

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There is no conflict of interest between authors.

Ethical approval

The Ethical Committee of the Gulhane School of Medicine (Etlik-Ankara, Turkey) approved the study.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Afsar, B., Yilmaz, M.I., Siriopol, D. et al. Thyroid function and cardiovascular events in chronic kidney disease patients. J Nephrol 30, 235–242 (2017). https://doi.org/10.1007/s40620-016-0300-y

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  • DOI: https://doi.org/10.1007/s40620-016-0300-y

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