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Kidney Week

Abstract: FR-PO212

Thyroid Hormones and CKD in the German CKD (GCKD) Study

Session Information

Category: CKD (Non-Dialysis)

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

Authors

  • Schultheiss, Ulla T., Medical Center - University of Freiburg, Freiburg, Germany
  • Poguntke, Inga, Medical Center - University of Freiburg, Freiburg, Germany
  • Sekula, Peggy, Medical Center - University of Freiburg, Freiburg, Germany
  • Eckardt, Kai-Uwe, University Medicine-Charite, Berlin, Germany
  • Baid-Agrawal, Seema, Sahlgrenska University Hospital, University of Gothenburg, Gothenburrg, Sweden
  • Schaeffner, Elke, Institute of Public Health - Charite, Berlin, Germany
  • Kottgen, Anna, Medical Center - University of Freiburg, Freiburg, Germany
Background

Clinical and translational research support a connection between kidney and thyroid function, e.g. hypothyroidism and low triiodothyronine (FT3) levels in combination with normal thyroid stimulating hormone (TSH) levels (= Euthyroid Sick Syndrome: ESS) and CKD. The relationship between these conditions and CKD progression is understudied. We evaluated the longitudinal association of TSH, free thyroxine (FT4), FT3, and thyroid diseases with a composite endpoint of renal events.

Methods

Thyroid markers were measured at baseline using standard laboratory methods. GFR was estimated using the CKD-EPI formula. Over four years of follow-up, 449 renal events occurred among 4,391 GCKD participants. Renal events included ESRD (dialysis, transplantation), acute kidney injury, or renal death abstracted from hospital records by trained personnel. Cox proportional hazard models of time to the composite outcome adjusted for age, sex, study site, smoking, BMI, history of cardiovascular disease, diabetes mellitus, and proteinuria were evaluated for continuous thyroid markers as well as for thyroid diseases (hypothyroidism: TSH>3.29, FT4≥9.8-18.8 or TSH>3.29, FT4<9.8; ESS: TSH≥0.49-3.29, FT3<3.3).

Results

Mean age was 60 years, with 59.4% males. Medians were TSH: 1.2 mIU/L, FT4: 14.3 pmol/L and FT3: 4.2 pmol/L; hypothyroidism and ESS were present in 5.0% and 5.4%. Thyroid hormone substitution was 21.0%.
No association was observed for TSH and FT4, FT3 was significantly associated (HR 0.8, 95%CI 0.7-0.9). Compared to euthyroid patients, hypothyroid patients had a 1.6-fold higher risk and patients suffering from ESS had a 2.0-fold higher risk of reaching the composite endpoint (Table 1). Excluding patients on thyroid medication: the associations with FT3 and ESS remained (FT3: HR 0.7, 95%CI 0.7-0.9; ESS: HR 1.9, 95%CI 1.3-2.7), the association with hypothyroidism disappeared.

Conclusion

Lower FT3 levels, hypothyroidism and ESS were associated with a higher risk of a composite renal endpoint in a population with CKD stage 3 and at risk for thyroid dysfunction.

Association results between the composite renal endpoints and thyroid function
 Hazard Ratio95% Confidence Intervalp-value
FT30.80.7-0.9<0.001
Hypothyroidism1.61.1-2.20.008
ESS2.01.5-2.6<0.001

Funding

  • Government Support - Non-U.S.