title: Thyroid function and cardiovascular events in chronic kidney disease patients.
abstract: OBJECTIVE
  Abnormalities of thyroid function are commonly seen in chronic kidney disease (CKD) patients. They are associated with adverse clinical conditions such as atherosclerosis, endothelial dysfunction, inflammation and abnormal blood pressure variability. We investigated the association between thyroid disorders and endothelial function, assessed by flow-mediated dilatation (FMD) and carotid intima-media thickness (CIMT), and cardiovascular events (CVE) in CKD patients.
  
  
  METHODS
  This observational cohort study included 305 CKD (stages 1-5) patients. Routine biochemistry, including free T3, free T4 and thyroid stimulating hormone, fibroblast growth factor-23 (FGF-23) and FMD, CIMT were measured. We divided patients into four groups according to thyroid hormone status: euthyroidism, subclinical hyperthyroidism, subclinical hypothyroidism, and euthyroid sick syndrome. Fatal and composite CVE were recorded for a median 29 months.
  
  
  RESULTS
  Patients with subclinical hypothyroidism had a higher prevalence of hypertension and diabetes and also were more likely to have higher values of systolic CIMT, phosphorus, intact parathormone (iPTH), FGF-23, homeostasis model assessment-insulin resistance and lower levels of FMD than euthyroid patients. In the unadjusted survival analysis, subclinical hypothyroidism and euthyroid sick syndrome were associated with an increased risk for the outcome as compared with euthyroidism [hazard ratio 30.63 (95 % confidence interval 12.27-76.48) and 12.17 (3.70-39.98), respectively]. The effects of subclinical hypothyroidism and euthyroid sick syndrome were maintained even in fully adjusted models.
  
  
  CONCLUSIONS
  We demonstrated that subclinical hypothyroidism and euthyroid sick syndrome are associated with increased CVE in CKD patients. Further studies are needed to explore these issues.
authors.affiliation: Department of Nephrology, Konya Numune State Hospital, Konya, Turkey.
authors.forename: Baris
authors.initials: B
authors.lastname: Afsar
authors.affiliation: Department of Nephrology, Gulhane School of Medicine, Ankara, Turkey.
authors.forename: Mahmut Ilker
authors.initials: MI
authors.lastname: Yilmaz
authors.affiliation: Nephrology Clinic, Dialysis and Renal Transplant Center, 'C.I. PARHON' University Hospital, 'Grigore T. Popa' University of Medicine, Iasi, Romania.
authors.forename: Dimitrie
authors.initials: D
authors.lastname: Siriopol
authors.affiliation: Department of Nephrology, Gulhane School of Medicine, Ankara, Turkey.
authors.forename: Hilmi Umut
authors.initials: HU
authors.lastname: Unal
authors.affiliation: Department of Radiology, Gulhane School of Medicine, Ankara, Turkey.
authors.forename: Mutlu
authors.initials: M
authors.lastname: Saglam
authors.affiliation: Department of Nephrology, Gulhane School of Medicine, Ankara, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Karaman
authors.affiliation: Department of Nephrology, Gulhane School of Medicine, Ankara, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Gezer
authors.affiliation: Department of Endocrinology, Gulhane School of Medicine, Ankara, Turkey.
authors.forename: Alper
authors.initials: A
authors.lastname: Sonmez
authors.affiliation: Department of Nephrology, Gulhane School of Medicine, Ankara, Turkey.
authors.forename: Tayfun
authors.initials: T
authors.lastname: Eyileten
authors.affiliation: Department of Endocrinology, Gulhane School of Medicine, Ankara, Turkey.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Aydin
authors.affiliation: Department of Biochemistry, Gulhane School of Medicine, Ankara, Turkey.
authors.forename: Salih
authors.initials: S
authors.lastname: Hamcan
authors.affiliation: Department of Nephrology, Gulhane School of Medicine, Ankara, Turkey.
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Oguz
authors.affiliation: Nephrology Clinic, Dialysis and Renal Transplant Center, 'C.I. PARHON' University Hospital, 'Grigore T. Popa' University of Medicine, Iasi, Romania.
authors.forename: Adrian
authors.initials: A
authors.lastname: Covic
authors.affiliation: Department of Nephrology, Gulhane School of Medicine, Ankara, Turkey. drkanbay@yahoo.com.|Department of Medicine, Division of Nephrology, Koc University School of Medicine, Topkapı, 03490, Istanbul, Turkey. drkanbay@yahoo.com.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Kanbay
mesh_terms: D000328:Adult; D000368:Aged; D058070:Asymptomatic Diseases; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D059168:Carotid Intima-Media Thickness; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005067:Euthyroid Sick Syndromes / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000097:blood; D006801:Humans; D006940:Hyperemia / Q000503:physiopathology; D007037:Hypothyroidism / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D018836:Inflammation Mediators / Q000097:blood; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D012307:Risk Factors; D013960:Thyroid Function Tests; D013961:Thyroid Gland / Q000378:metabolism / Q000503:physiopathology*; D013963:Thyroid Hormones / Q000097:blood; D014421:Turkey / Q000453:epidemiology; D014664:Vasodilation
chemical_list: D015415:Biomarkers; C000717427:FGF23 protein, human; D018836:Inflammation Mediators; D013963:Thyroid Hormones; D005346:Fibroblast Growth Factors; D000089703:Fibroblast Growth Factor-23
keywords: Cardiovascular disease; Chronic kidney disease; Thyroid disorders