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Abstract: PO0485

Thyroid Status and Mortality Among CKD Patients Transitioning to Dialysis

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Li, Jia, University of California Irvine, Irvine, California, United States
  • You, Amy Seung, University of California Irvine, Irvine, California, United States
  • Brent, Gregory, University of California Los Angeles, Los Angeles, California, United States
  • Streja, Elani, University of California Irvine, Irvine, California, United States
  • Maryska, Dorsa F., Kidney Specialists Medical Corporation, Los Angeles, California, United States
  • Thornhill-Joynes, Monica, Kidney Specialists Medical Corporation, Los Angeles, California, United States
  • Narasaki, Yoko, University of California Irvine, Irvine, California, United States
  • Hsiung, Jui-Ting, University of California Irvine, Irvine, California, United States
  • Wenziger, Cachet, University of California Irvine, Irvine, California, United States
  • Park, Christina, University of California Irvine, Irvine, California, United States
  • Sim, John J., Kaiser Permanente Southern California, Pasadena, California, United States
  • Nguyen, Danh V., University of California Irvine, Irvine, California, United States
  • Kovesdy, Csaba P., The University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Kalantar-Zadeh, Kamyar, University of California Irvine, Irvine, California, United States
  • Rhee, Connie, University of California Irvine, Irvine, California, United States
Background

Hypothyroidism has been associated with higher death risk in non-dialysis dependent chronic kidney disease (NDD-CKD) and end-stage renal disease (ESRD) patients, presumably due to cardiovascular pathways. We examined whether pre-ESRD thyroid status is a predictor of survival in NDD-CKD patients transitioning to dialysis.

Methods

Among US Veterans with NDD-CKD transitioning to dialysis from 10/2007-3/2015, we examined the association of serum thyrotropin (TSH) levels averaged over a three-year pre-ESRD transition period (“pre-ESRD prelude period”) with post-ESRD mortality. Patients were followed for the outcome for up to three-years, and HRs for all-cause mortality were estimated using expanded case-mix+laboratory adjusted Cox models. In sensitivity analyses, we examined varying pre-ESRD prelude and post-ESRD mortality intervals.

Results

Among 43,161 patients in the primary cohort (three-year pre-ESRD prelude cohort), increasingly higher TSH levels >3.0mIU/L were associated with incrementally higher mortality (ref: TSH 0.5-<3.0mIU/L): adjusted HRs (95%CI) 1.04 (0.95-1.13), 1.04 (1.00-1.07), and 1.16 (1.11-1.22) for TSH levels of <0.5, 3.0-5.0, and >5.0mIU/L, respectively. A similar pattern of findings was observed for patients whose TSH levels were examined over one-year and two-year pre-ESRD prelude periods, with follow-up for the outcome of interest for up to one and two years, respectively.

Conclusion

There was a dose-dependent relationship between higher pre-ESRD TSH levels exceeding 3.0mIU/L and higher post-ESRD mortality in NDD-CKD patients transitioning to dialysis. Further studies are needed to determine the underlying determinants of thyroid dysfunction in CKD, and whether reduction of TSH levels with thyroid hormone supplementation ameliorates mortality in this population.

Funding

  • NIDDK Support