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Subclinical hypothyroidism is independently associated with poor renal outcomes in patients with chronic kidney disease

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Abstract

Purpose

It remains unclear whether subclinical hypothyroidism (SCH) is associated with renal prognosis in patients with chronic kidney disease (CKD). Therefore, we prospectively investigated the association of SCH with renal outcomes in CKD.

Methods

We conducted a prospective observational study of 480 euthyroid patients and 89 patients with SCH. The endpoints were defined as a composite of doubling of serum creatinine (SCr), end-stage renal disease (ESRD), or death, and a composite of doubling of SCr or ESRD was added as an alternative outcome. Logistic regression analyses were used to identify the factors associated with SCH. In addition, a Cox proportional hazards model was performed to determine whether SCH was associated with poor renal outcomes.

Results

During a median follow-up period of 26.1 months, doubling of SCr, ESRD, or death and doubling of SCr or ESRD occurred in 244 and 213 patients, respectively. In univariable logistic regression analyses, SCH was significantly associated with older age, lower hemoglobin, higher proteinuria, lower estimated glomerular filtration rate (eGFR), and higher log B-type natriuretic peptide (BNP). Multivariable Cox analyses showed that SCH was associated with poorer renal outcomes after adjustment for covariates, including eGFR and log BNP [doubling of SCr, ESRD, or death: hazard ratio (HR) 1.61, 95% confidence interval (CI), 1.16–2.23; doubling of SCr or ESRD: HR 1.53, 95% CI 1.07–2.20], compared with euthyroidism.

Conclusions

In CKD, SCH is independently associated with poor renal outcomes, suggesting that screening for SCH might be needed to accurately predict renal prognosis.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors would like to express their gratitude to the 569 participants of the study and to the cardiologists who performed the echocardiography. The authors would also thank Mark Cleasby, Ph.D., from Edanz Group (https://en-author-services.edanzgroup.com/ac) for editing a draft of this manuscript.

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Authors and Affiliations

  1. Division of Nephrology and Clinical Research Institute, Department of Internal Medicine, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka, 810-8563, Japan

    Susumu Tsuda, Masaru Nakayama, Yuta Matsukuma, Ryota Yoshitomi, Naoki Haruyama & Akiko Fukui

  2. Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Toshiaki Nakano & Takanari Kitazono

  3. Department of Nephrology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan

    Kazuhiko Tsuruya

Authors
  1. Susumu Tsuda
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  2. Masaru Nakayama
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  3. Yuta Matsukuma
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  4. Ryota Yoshitomi
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  5. Naoki Haruyama
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  6. Akiko Fukui
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  7. Toshiaki Nakano
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  8. Kazuhiko Tsuruya
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  9. Takanari Kitazono
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Contributions

S.T. and M.N. contributed to the study conception, study design, and data interpretation, and wrote the manuscript. Y.M. contributed to the study conception, study design, and data interpretation. R.Y., N.H., and A.F. contributed to the data acquisition and data interpretation. T.N., K.T., and T.K. contributed to the data interpretation and reviewed and revised the manuscript. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Masaru Nakayama.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Written informed consent was obtained from all the participants included in this study.

Ethics

This study was approved by the Ethics Committee of the National Hospital Organization Kyushu Medical Center (Approval Number: 09-09) and was registered at the University Hospital Medical Information Network (UMIN000017519).

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Tsuda, S., Nakayama, M., Matsukuma, Y. et al. Subclinical hypothyroidism is independently associated with poor renal outcomes in patients with chronic kidney disease. Endocrine 73, 141–150 (2021). https://doi.org/10.1007/s12020-021-02611-6

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  • DOI: https://doi.org/10.1007/s12020-021-02611-6

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