title: Thyroid hormone abnormalities in hemodialyzed patients: low triiodothyronine as well as high reverse triiodothyronine are associated with increased mortality.
abstract: Numerous abnormalities of thyroid hormones in end-stage renal disease (ESRD) have been described. Our aim was to analyze the impact of these abnormalities on survival. In 167 hemodialyzed ESRD patients, TSH and thyroid hormone levels (T4, fT4, T3, fT3, rT3) were determined. The patients were then prospectively followed up for up to 5 years and the possible impact of any observed abnormalities on their mortality was studied. Only 16.8 % patients had all six tests within the reference range. The pattern of nonthyroidal illness syndrome was found in 56.3 %. Low T3 was particularly common (44.3 %), and clearly associated with increased 6- and 12-month mortality and decreased overall survival (log rank test, P=0.007). Independent of T3 levels (Spearman correlation, NS), increased rT3 was more frequently observed (9.9 %) than expected from the literature, and was also related to increased mortality and decreased survival (log rank test, P=0.021). Increased rT3 may be more common in ESRD patients than previously described, and together with decreased T3 it may serve as an indicator of poor prognosis in subsequent months.
authors.affiliation: Department of Internal Medicine IV, Faculty of Medicine and University Hospital Hradec Králové, Charles University in Prague, Hradec Králové, Czech Republic. horacek9@gmail.com
authors.forename: J
authors.initials: J
authors.lastname: Horáček
authors.forename: S
authors.initials: S
authors.lastname: Dusilová Sulková
authors.forename: M
authors.initials: M
authors.lastname: Kubišová
authors.forename: R
authors.initials: R
authors.lastname: Safránek
authors.forename: E
authors.initials: E
authors.lastname: Malířová
authors.forename: M
authors.initials: M
authors.lastname: Kalousová
authors.forename: I
authors.initials: I
authors.lastname: Svilias
authors.forename: J
authors.initials: J
authors.lastname: Malý
authors.forename: L
authors.initials: L
authors.lastname: Sobotka
authors.forename: P
authors.initials: P
authors.lastname: Zák
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D018153:Czech Republic / Q000453:epidemiology; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000175:diagnosis / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D006435:Renal Dialysis / Q000401:mortality*; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D015996:Survival Rate; D014284:Triiodothyronine / Q000097:blood*
chemical_list: D015415:Biomarkers; D014284:Triiodothyronine