ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: SA-PO690

Natural History of Thyroidal Functional Disease in Peritoneal Dialysis

Session Information

  • Peritoneal Dialysis - II
    November 04, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Dialysis

  • 608 Peritoneal Dialysis

Authors

  • Szelag, Jean-christophe, AURAL, LYON, France
  • Cardozo, Carlos, AURAL, LYON, France
  • Pastural, Myriam, AURAL, LYON, France
  • Laville, Maurice, AURAL, LYON, France
Background

Thyroidal functional disease (TFD) is frequent in chronic kidney disease. The main reported abnormalities are hypothyroidism, especially in its subclinical pattern (SCH), and low circulating triiodothyronine (low T3 syndrome).
Recent data has established a link between TFD and mortality in stage V CKD, however, little is known about the natural evolution of TFD in end stage renal disease patients, especially treated with peritoneal dialysis.

Methods

We studied a cohort of 114 incident peritoneal dialysis patients (mean follow up,23 +/- 19 months; men: 59,6%, diabetes: 25%, 61,7+/-16.6 years old) tested for thyroid function on a quarterly basis. THS above the highest normal lab value (4.2 mIU/L) with normal fT4 defined SCH, an isolated fT3 below the lowest normal lab value ( 2,5 pmol/L) defined low T3 syndrome, in untreated patients.

Results

At baseline, 96 patients were euthyroid, 17 (14,9%) displayed a SCH and only one a low fT3 condition (0,8%). Low fT3 corrected in less than three months. Thyroid function corrected in all but two SCH patients along an average period of 9 +/- 7,7 months. A late recurrence was observed in one patient. Multivariate analysis didn’t suspect any predictive variable associated with baseline SCH (age, sex, diabetes, hemodialysis before PD, cardio-renal syndrome, nutrition status, inflammation status) while two previous stories of thyroiditis and one exposition to amiodarone were found in three patients with persistent/recurrent SCH.
Eight patients (8,3%) with normal thyroidal status at baseline subsequently evolved to SCH (4) or low fT3 syndrome (4) after a mean follow up of 6,2 +/-5,9 and 7,1+/-6,9 months, respectively. Diabetes (SCH, p= 0,02) and albuminemia (low fT3, p=0,043) were the only factors associated with the occurrence of a thyroid disturbance in baseline euthyroid patients. Of interest, low fT3 was always transient and disappeared spontaneously while SCH became a constant disorder in all but one patient (75%), No patient developed overt hypothyroidism over the follow-up.

Conclusion

SCH is highly prevalent in patients starting PD but disappeared within the first year in the absence of previous thyroid disease. Its signification could be different when occurring in initially euthyroid individuals. Low fT3 syndrome is less common and seems to be a transient condition associated with albumin variations.