Chronic kidney disease and thyroid hormones

Yuan Cheng; Haofei Hu; Wangyang Li; Sheng Nie; Shiyu Zhou; Yuna Chen; Tao Cao; Hong Xu; Bicheng Liu; Chunbo Chen; Huafeng Liu; Qiongqiong Yang; Hua Li; Yaozhong Kong; Guisen Li; Yan Zha; Ying Hu; Gang Xu; Yongjun Shi; Yilun Zhou; Guobin Su; Ying Tang; Mengchun Gong; Qijun Wan

doi:10.1210/clinem/dgae841

Chronic kidney disease and thyroid hormones

J Clin Endocrinol Metab. 2024 Dec 9:dgae841. doi: 10.1210/clinem/dgae841. Online ahead of print.

Authors

Yuan Cheng¹, Haofei Hu¹, Wangyang Li¹, Sheng Nie², Shiyu Zhou², Yuna Chen¹, Tao Cao¹, Hong Xu³, Bicheng Liu⁴, Chunbo Chen⁵, Huafeng Liu⁶, Qiongqiong Yang⁷, Hua Li⁸, Yaozhong Kong⁹, Guisen Li¹⁰, Yan Zha¹¹, Ying Hu¹², Gang Xu¹³, Yongjun Shi¹⁴, Yilun Zhou¹⁵, Guobin Su¹⁶, Ying Tang¹⁷, Mengchun Gong^{18

19}, Qijun Wan¹

Affiliations

¹ Department of Nephrology, The Second People's Hospital of Shenzhen; The First Affiliated Hospital of Shenzhen University, Shenzhen, China.
² Division of Nephrology, Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology; Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China.
³ Children's Hospital of Fudan University, Shanghai, China.
⁴ Institute of Nephrology, Zhongda Hospital, Southeast University School of Medicine, Nanjing, China.
⁵ Department of Critical Care Medicine, Maoming People's Hospital, Maoming, China.
⁶ Key Laboratory of Prevention and Management of Chronic Kidney Disease of Zhanjiang City, Institute of Nephrology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China.
⁷ Department of Nephrology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
⁸ Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
⁹ Department of Nephrology, the First People's Hospital of Foshan, Foshan, Guangdong, China.
¹⁰ Renal Department and Institute of Nephrology, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Sichuan Clinical Research Center for Kidney Diseases, Chengdu, China.
¹¹ Guizhou Provincial People's Hospital, Guizhou University, Guiyang, China.
¹² The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
¹³ Division of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
¹⁴ Huizhou Municipal Central Hospital, Sun Yat-Sen University, Huizhou, China.
¹⁵ Department of Nephrology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
¹⁶ Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital, The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China.
¹⁷ The Third Affiliated Hospital of Southern Medical University, Guangzhou, China.
¹⁸ Institute of Health Management, Southern Medical University, Guangzhou, China.
¹⁹ DHC Technologies, Beijing, China.

PMID: 39657910
DOI: 10.1210/clinem/dgae841

Abstract

Introduction: Thyroid dysfunction is prevalent in chronic kidney disease (CKD) patients and significantly impacts renal outcomes and mortality. This study investigated the associations between thyroid function and clinical outcomes, and also the therapeutic effects of thyroid hormone replacement therapy (THRT) in CKD patients.

Methods: We conducted a retrospective cohort study using data from the China Renal Data System. The primary endpoints were composite renal failure and all-cause mortality. The secondary endpoint was the impact of THRT on renal outcomes. Associations were analyzed using multivariable Cox proportional hazards regression models and Kaplan-Meier survival analyses, with adjustment for relevant clinical and demographic covariates.

Results: Among 30,804 CKD patients enrolled, 26,673 (86.6%) had normal thyroid function, 2,291 (7.4%) had hypothyroidism, and 1,840 (6.0%) had hyperthyroidism. Hypothyroidism independently predicted increased risk of renal failure (adjusted HR=1.29; 95%CI: 1.15-1.45; p<0.001). Both hypothyroidism (adjusted HR=1.24; 95%CI: 1.11-1.39; p<0.001) and hyperthyroidism (adjusted HR=1.20; 95%CI: 1.07-1.33; p<0.01) were associated with increased all-cause mortality. Notably, THRT was associated with significantly reduced risk of renal failure (adjusted HR=0.65; 95%CI: 0.52-0.82; p<0.001) in hypothyroid patients.

Conclusion: This large-scale cohort study demonstrates that hypothyroidism accelerates CKD progression, while both hypo- and hyperthyroidism increase mortality risk in CKD patients. THRT appears to attenuate the adverse effects of hypothyroidism on renal function. Regular thyroid function monitoring and appropriate THRT should be considered in CKD management.

Keywords: all-cause mortality; chronic kidney disease; renal failure; thyroid hormone replacement therapy; thyroid hormones.

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