Thyroid function and cardiovascular events in chronic kidney disease patients

Area of Science:

• Nephrology
• Endocrinology
• Cardiology

Background:

• Thyroid dysfunction is common in chronic kidney disease (CKD).
• Thyroid abnormalities are linked to adverse conditions like atherosclerosis and endothelial dysfunction.
• The relationship between thyroid disorders, endothelial function, and cardiovascular events (CVE) in CKD patients requires further investigation.

Purpose of the Study:

• To investigate the association between thyroid disorders and endothelial function (flow-mediated dilatation [FMD] and carotid intima-media thickness [CIMT]).
• To assess the link between thyroid disorders and cardiovascular events (CVE) in CKD patients.

Main Methods:

• An observational cohort study included 305 CKD patients (stages 1-5).
• Thyroid hormones (free T3, free T4, TSH), FGF-23, FMD, and CIMT were measured.
• Patients were categorized into euthyroidism, subclinical hyperthyroidism, subclinical hypothyroidism, and euthyroid sick syndrome groups. Fatal and composite CVE were recorded over a median of 29 months.

Main Results:

• Subclinical hypothyroidism was associated with higher prevalence of hypertension, diabetes, increased CIMT, phosphorus, iPTH, FGF-23, insulin resistance, and lower FMD compared to euthyroid patients.
• Both subclinical hypothyroidism and euthyroid sick syndrome were significantly associated with an increased risk of CVE in unadjusted and fully adjusted survival analyses.
• Hazard ratios for subclinical hypothyroidism and euthyroid sick syndrome were 30.63 and 12.17, respectively.

Conclusions:

• Subclinical hypothyroidism and euthyroid sick syndrome are associated with increased cardiovascular events in CKD patients.
• These thyroid abnormalities represent significant risk factors for CVE in this population.
• Further research is warranted to explore these associations and potential interventions.