title: Association of thyroid functional disease with mortality in a national cohort of incident hemodialysis patients.
abstract: BACKGROUND
  Hypothyroidism is a common condition that disproportionately affects hemodialysis patients. In the general population, hypothyroidism is associated with higher mortality, particularly in populations with underlying cardiovascular risk. Despite their heightened cardiovascular mortality, the impact of hypothyroidism on the survival of hemodialysis patients remains uncertain.
  
  
  OBJECTIVE
  To examine whether hypothyroidism is independently associated with higher mortality in hemodialysis patients.
  
  
  METHODS
  Among 8840 incident hemodialysis patients receiving care from a large national dialysis provider from January 2007 to December 2011, we examined the association of hypothyroidism (TSH >5.0 mIU/L) with mortality.
  
  
  METHODS
  Associations between baseline and time-dependent hypothyroidism with all-cause mortality were determined using case-mix adjusted Cox models. In secondary analyses, we examined the impact of low-normal, upper-normal, subclinical range, and overt range TSH levels (TSH ≥ 0.5-3.0, >3.0-5.0, >5.0-10.0, and >10.0 mIU/L, respectively) on mortality risk.
  
  
  RESULTS
  The study population consisted of 1928 (22%) hypothyroid and 6912 (78%) euthyroid patients. Baseline and time-dependent hypothyroidism were associated with higher mortality: adjusted hazard ratios (95% confidence intervals) were 1.47 (1.34-1.61) and 1.62 (1.45-1.80), respectively. Compared to low-normal TSH, upper-normal, subclinical hypothyroid, and overt hypothyroid TSH levels were associated with incrementally higher adjusted death risk in baseline and time-dependent analyses. In time-dependent analyses, the hypothyroidism-mortality association was increasingly stronger across higher body mass index strata.
  
  
  CONCLUSIONS
  Hypothyroidism as well as upper-normal TSH levels are associated with higher mortality in hemodialysis patients. Further studies are needed to determine whether restoration of TSH to low-normal levels with thyroid hormone replacement therapy ameliorates adverse outcomes in hemodialysis patients.
authors: Harold Simmons Center for Chronic Disease Research and Epidemiology (C.M.R., K.K.-Z.), Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, California 92868; Los Angeles Biomedical Research Institute (C.M.R., K.K.-Z.), Harbor-UCLA Medical Center Torrance, California 90502; Department of Statistics (S.K., D.L.G., T.O., J.W.), University of California Irvine School of Medicine, Irvine, California 92697; Division of Nephrology (R.M., S.K.), Harborview Medical Center, University of Washington, Seattle, Washington 98104; Division of General Internal Medicine (D.V.N.), University of California Irvine Medical Center, Orange, California 92868; DaVita Clinical Research (S.M.B.), Minneapolis, Minnesota 55404; Nephrology Section (C.P.K.), Memphis Veterans Affairs Medical Center, Memphis, Tennessee 38104; Division of Nephrology (C.P.K.), University of Tennessee Health Science Center, Memphis, Tennessee 38163; and Division of Endocrinology (G.A.B.), University of California Los Angeles, Los Angeles, California 90095.
authors: Connie M
authors: CM
authors: Rhee
authors: Steven
authors: S
authors: Kim
authors: Daniel L
authors: DL
authors: Gillen
authors: Tolga
authors: T
authors: Oztan
authors: Jiaxi
authors: J
authors: Wang
authors: Rajnish
authors: R
authors: Mehrotra
authors: Sooraj
authors: S
authors: Kuttykrishnan
authors: Danh V
authors: DV
authors: Nguyen
authors: Steven M
authors: SM
authors: Brunelli
authors: Csaba P
authors: CP
authors: Kovesdy
authors: Gregory A
authors: GA
authors: Brent
authors: Kamyar
authors: K
authors: Kalantar-Zadeh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000150:complications / Q000401:mortality; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007037:Hypothyroidism / Q000150:complications* / Q000401:mortality*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000401:mortality*; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000628:therapy*; D016019:Survival Analysis; D013960:Thyroid Function Tests; D013972:Thyrotropin / Q000097:blood; D014481:United States / Q000453:epidemiology
chemical_list: D013972:Thyrotropin
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