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Thyroid Stimulating Hormone Levels and Risk of Hospital-Acquired Acute Kidney Injury: A Nationwide Cohort Study
Caoxiang She1, Yaduan Lin1, Yanan Xie1
1Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Multiorgan Injury Prevention and Treatment, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China.
Rationale & Objective:
The thyroid-renal interaction remains underexplored in acute kidney injury pathophysiology. We aimed to investigate the relationship between thyroid status, defined by thyroid-stimulating hormone (TSH) levels, and incident hospital-acquired acute kidney injury (HA-AKI).
Study Design:
A retrospective cohort study.
Setting & Participants:
Patients with TSH quantification within 48 hours after admission from the China Renal Data System (CRDS) database.
Exposures:
Three TSH levels groups, including hyperthyroid (TSH ≤ 0.5 mIU/L), euthyroid (0.5 < TSH ≤ 5.0 mIU/L), and hypothyroid (TSH > 5.0 mIU/L) TSH levels.
Outcomes:
The primary outcome was HA-AKI.
Analytical Approach:
Multivariable Cox hazard regression models and restricted cubic spline.
Results:
A total of 20,317 (5.4%) patients developed HA-AKI, with incidences rates of 8.0%, 5.0%, and 6.4% in patients with hyperthyroid, euthyroid, and hypothyroid TSH levels, respectively. Compared with patients with euthyroid TSH levels, those with hyperthyroid or hypothyroid TSH levels were associated with an increased risk of HA-AKI (hyperthyroid TSH levels: adjusted hazard ratio [aHR], 1.28; 95% confidence interval [CI], 1.21-1.37; P < 0.001; hypothyroid TSH levels: aHR, 1.10; 95% CI, 1.01-1.21; P = 0.03). Additionally, the dose-response curve showed a U-shaped relationship between TSH levels and the risk of new-onset HA-AKI.
Limitations:
Possible residual confounding.
Conclusions:
TSH levels in the low (≤0.5 mIU/L) and high (>5.0 mIU/L) ranges were associated with increased risk of HA-AKI. These insights suggest that enhanced vigilance toward AKI may be justifiable in patients with thyroid dysfunction.
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