title: Impact of thyroid dysfunction on erythropoietin dosage in hemodialysis patients.
abstract: BACKGROUND
  Although thyroid diseases exist in patients with renal failure, thyroid function tests are not routine tests in patients on chronic hemodialysis (HD). Therefore, the impact of thyroid diseases on erythropoietin (EPO) dosage in HD patients is not well defined. This study evaluated the relationship between the dose of EPO and the presence or absence of thyroid dysfunction in HD patients.
  
  
  METHODS
  This study included 1013 adult patients on HD who did not have a malignancy, liver cirrhosis, thalassemia, iron deficiency, gastrointestinal bleeding, or a major operation within 6 months. Patients were characterized as being euthyroid, or having the sick euthyroid syndrome, primary hypothyroidism, subclinical hypothyroidism, hyperthyroidism, or subclinical hyperthyroidism based on thyroid function tests. Routine biochemistry profiles including an index of the efficiency of HD, along with clinical data over the previous 6-month period, were collected and analyzed. Multiple regression models were employed to assess the relationship between the dose of EPO and the presence or absence of thyroid status.
  
  
  RESULTS
  The mean monthly EPO dosages were 77.7±37.0, 70.2±40.6, 90.8±68.4, 78.5±46.7, and 82.3±41.2 μg, respectively, in the sick euthyroid syndrome, euthyroid patients, hypothyroidism, subclinical hypothyroidism, and subclinical hyperthyroidism groups (p<0.05). After adjustment of all other variables in multiple regression, the mean monthly EPO dosage was 19.00±8.59 μg more in hypothyroid patients compared with euthyroid patients (p=0.027). Further, considering an interaction with the presence of diabetes, the mean monthly EPO dosage in patients with either hypothyroidism or subclinical hypothyroidism and diabetes was 54.66±17.12 μg (p=0.001) and 31.51±10.38 μg more than that of euthyroid patients, respectively (p=0.002).
  
  
  CONCLUSIONS
  In HD patients, the EPO dosage required to maintain the target hemoglobin level is significantly higher in patients having both hypothyroidism or subclinical hypothyroidism and diabetes than in euthyroid patients.
authors.affiliation: Divisions of Nephrology, Department of Medicine, Taipei Veterans' General Hospital, Taipei, Taiwan. yyng@vghtpe.gov.tw
authors.forename: Yee Yung
authors.initials: YY
authors.lastname: Ng
authors.forename: Hong Da
authors.initials: HD
authors.lastname: Lin
authors.forename: Shiao Chi
authors.initials: SC
authors.lastname: Wu
authors.forename: Chih Yu
authors.initials: CY
authors.lastname: Yang
authors.forename: Wu Chang
authors.initials: WC
authors.lastname: Yang
authors.forename: Hung Hsiang
authors.initials: HH
authors.lastname: Liou
authors.forename: Fen Hsiang
authors.initials: FH
authors.lastname: Hu
authors.forename: Chun Cheng
authors.initials: CC
authors.lastname: Hou
authors.forename: Su Shan
authors.initials: SS
authors.lastname: Tseng
authors.forename: Nai Yung
authors.initials: NY
authors.lastname: Ku
authors.forename: Nien Yung
authors.initials: NY
authors.lastname: Hsiao
authors.forename: Wen Chieh
authors.initials: WC
authors.lastname: Wu
authors.forename: Hsing Meng
authors.initials: HM
authors.lastname: Tu
authors.forename: Tse-Jen
authors.initials: TJ
authors.lastname: Lien
authors.forename: Chung Ching
authors.initials: CC
authors.lastname: Lee
authors.forename: Kwong Kee
authors.initials: KK
authors.lastname: Tsang
authors.forename: Chen Seng
authors.initials: CS
authors.lastname: Cheng
authors.forename: Jean
authors.initials: J
authors.lastname: Hu
authors.forename: Ru Ping
authors.initials: RP
authors.lastname: Lin
mesh_terms: D000368:Aged; D000743:Anemia, Hemolytic / Q000209:etiology / Q000517:prevention & control; D003430:Cross-Sectional Studies; D003928:Diabetic Nephropathies / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D016903:Drug Monitoring; D004921:Erythropoietin / Q000008:administration & dosage* / Q000627:therapeutic use; D005067:Euthyroid Sick Syndromes / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D006397:Hematinics / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D006980:Hyperthyroidism / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology; D007037:Hypothyroidism / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000627:therapeutic use; D006435:Renal Dialysis / Q000009:adverse effects*; D012720:Severity of Illness Index; D013624:Taiwan / Q000453:epidemiology; D013959:Thyroid Diseases / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D013961:Thyroid Gland / Q000503:physiopathology*
chemical_list: C554270:EPO protein, human; D006397:Hematinics; D011994:Recombinant Proteins; D004921:Erythropoietin