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Abstract: PO1748

Interplay Between Serum Thyrotropin, Free Thyroxine, and Thyroid Autoantibody Levels and Survival in a Prospective Hemodialysis Cohort

Session Information

Category: Health Maintenance, Nutrition, and Metabolism

  • 1300 Health Maintenance, Nutrition, and Metabolism

Authors

  • You, Amy Seung, University of California Irvine, Irvine, California, United States
  • Brent, Gregory, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, United States
  • Sim, John J., Kaiser Permanente Southern California, Pasadena, California, United States
  • Guerrero, Yalitzi, University of California Irvine, Irvine, California, United States
  • Kalantar, Sara S., University of California Berkeley, Berkeley, California, United States
  • Ahdoot, Rebecca, University of California Irvine, Irvine, California, United States
  • Narasaki, Yoko, University of California Irvine, Irvine, California, United States
  • Nguyen, Matthew Duy Thanh Luyen, University of California Irvine, Irvine, California, United States
  • Kovesdy, Csaba P., The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States
  • Nguyen, Danh V., University of California Irvine, Irvine, California, United States
  • Kalantar-Zadeh, Kamyar, University of California Irvine, Irvine, California, United States
  • Rhee, Connie, University of California Irvine, Irvine, California, United States
Background

CKD patients have a high prevalence of hypothyroidism (elevated serum thyrotropin [TSH]) which has been associated with worse survival. In patients with altered protein-hormone binding states (uremia, low/high circulating proteins) among whom routine “indirect” free thyroxine (FT4) assays are not as accurate, little is known about the impact of subclinical (high TSH+normal FT4) and overt (high TSH+low FT4) hypothyroidism and thyroid autoimmune status on hemodialysis (HD) survival.

Methods

In a multicenter prospective cohort of 1117 HD patients from the “Hypothyroidism, Cardiovascular Health, and Survival (HyCARDS)” Study, we conducted protocolized TSH, “direct” FT4 by equilibrium dialysis/tandem mass spectrometry (robust FT4 assessment method in altered protein-hormone binding), and anti-thyroid peroxidase antibody (anti-TPO Ab) assays every 6 months from 2011-19. We examined associations of severity of thyroid dysfunction ascertained by TSH gradations (subclinical vs. overt hypothyroid-range TSH levels) and pairings of TSH+FT4 (subclinical vs. overt hypothyroidism), as well as presence of elevated anti-TPO Abs with mortality using time-varying Cox models.

Results

TSH distributions were higher in those with elevated anti-TPO Abs. In analyses of TSH gradations, elevated TSH was associated with higher mortality (ref: 0.5-<3.0): HRs (95%CI) 1.30 (0.96-1.77) and 1.88 (1.31-2.68) for TSH 3.0-5.0 and >5.0. In analyses of paired TSH+FT4, overt hypothyroidism was associated with higher mortality (aHR [95%CI] 5.11 [1.23-21.28]), while subclinical hypothyroidism trended towards higher mortality (aHR [95%CI] 1.63 [0.98-2.72]). Elevated anti-TPO Abs were not associated with death.

Conclusion

In a prospective cohort of HD patients who underwent rigorous thyroid status assessment, both mild (subclinical) and severe (overt) hypothyroidism were associated with higher mortality. Further studies are needed to determine if correction of thyroid status with thyroid hormone replacement therapy improves survival in this population.

Funding

  • NIDDK Support