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Abstract: FR-PO213

A Dose Dependent Relationship Between Hypothyroidism and CKD within a Real-World Clinical Environment

Session Information

Category: CKD (Non-Dialysis)

  • 1901 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Huang, Cheng-Wei, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, United States
  • Li, Bonnie H., Kaiser Permanente Southern California, Pasadena, California, United States
  • Rhee, Connie, University of California Irvine Medical Center, Orange, California, United States
  • Sim, John J., Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, United States
Background

Whether hypothyroidism (HT) engenders chronic kidney disease (CKD) is unknown. We sought to determine whether HT and different thyroid states are associated with CKD among a large diverse population.

Methods

A cross sectional study was performed among individuals with concurrent thyroid stimulating hormone (TSH) and creatinine measurements within Kaiser Permanente Southern California health system (1/1990-12/2017). Rates of CKD across different thyroid states were compared. Multivariable logistic regression analysis adjusted for age, sex, race, and comorbidities was performed to estimate odds ratios (ORs) for CKD by thyroid state. HT was defined as TSH>4mcIU/mL and/or receipt of thyroid hormone replacement. HT was further categorized into 1) hypothyroid state (HS): TSH>4mcIU/mL regardless of thyroid hormone replacement, and 2) attenuated-hypothyroid state (AS): TSH<4mcIU/mL and on thyroid hormone replacement. Euthyroid (ET) was defined as TSH<4mcIU/mL and on no thyroid hormone replacement. The primary outcome was CKD defined as eGFR<45mL/min/1.73m2.

Results

A total of 378,101 individuals were identified. Among 114,872 (30.4%) meeting criteria for HT, 31,242 (27.2%) were HS and 83,630 (72.8%) were AS. Compared to ET individuals, multivariable OR (95% confidence interval) for CKD (eGFR<45mL/min/1.73m2) were 1.59 (1.52-1.66) and 1.12 (1.08-1.16) for HS and AS respectively when compared to ET (Table 1).

Conclusion

Within a real-world clinical environment, there is a greater likelihood of CKD associated with HT. A stronger association was seen among those with HS compared to those with AS. Our findings suggest that there may be a dose dependent relationship between thyroid function and CKD. Whether treatment of hypothyroidism among CKD patients may improve and alter the course of CKD is an area warranting future investigation.

Table 1. Odds ratios of CKD (eGFR<45mL/min/1.73m2) across each thyroid state
Thyroid StateCrude OR (95% CI)Adjusted OR (95% CI)1Adjusted OR (95% CI)2
Hypothyroidism1.51 (1.47-1.55)1.25 (1.22-1.29)1.25 (1.21-1.29)
Hypothyroid state2.02 (1.94-2.11)1.56 (1.49-1.63)1.59 (1.52-1.66)
Attenuated hypothyroid state1.33 (1.28-1.37)1.13 (1.10-1.17)1.12 (1.08-1.16)
EuthyroidReferenceReferenceReference

1Adjusted for demographics including age, sex, and race 2Additionally adjusted for hypertension and diabetes