title: Treatment for non-thyroidal illness syndrome in advanced chronic kidney disease: a single-blind controlled study.
abstract: OBJECTIVE
  Non-thyroidal illness syndrome (NTIS) is common among patients with advanced chronic kidney disease (CKD) and is strongly associated with poor prognosis. However, it remains unclear in how to correct this disorder and this study aimed to evaluate the effectiveness of sodium bicarbonate (SB) and N-acetyl-cysteine (NAC) for correcting NTIS status.
  
  
  METHODS
  Patients with CKD stage 3-4 were single-blind, placebo-controlled treated with placebo, SB, or NAC for 18 weeks. The primary end points were the correction of NTIS and the occurrence of end-stage renal disease (ESRD). The secondary point was the change in estimated glomerular filtration rate (eGFR) after the follow-up.
  
  
  RESULTS
  The Kaplan-Meier survival analysis showed significant lower correcting ratio of NTIS in control group compared with SB group [Hazard ratio (HR) 0.19, 95 % confidence interval (CI) 0.04-0.89, p = 0.035] and NAC group (HR 0.09, 95 % CI 0.02-0.38, p = 0.001), and increased ESRD risk in control group than in SB group (HR 1.97, 95 % CI 1.02-3.84, p = 0.045) and NAC group (HR 5.50, 95 % CI 2.23-13.57, p < 0.001). The Cox regression analysis demonstrated significantly different effectiveness of placebo, SB and NAC on NTIS correction and ESRD risk, p < 0.05, respectively. Variance analysis displayed a greater reduction in eGFR in controls than in SB (p = 0.044) and NAC group (p < 0.001).
  
  
  CONCLUSIONS
  SB and NAC are effective in promoting the recovery from NTIS status and delaying the deterioration of renal function in advanced CKD patients.
authors.affiliation: Department of Nephrology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, People's Republic of China.
authors.forename: Wenjun
authors.initials: W
authors.lastname: Yan
authors.affiliation: Medical Center of the Graduate School, Nanchang University, Nanchang, People's Republic of China.
authors.forename: Lijuan
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Nephrology, The Second Affiliated Hospital of Nanchang University, 1, Minde Road, Nanchang, 330006, People's Republic of China.
authors.forename: Tianlun
authors.initials: T
authors.lastname: Huang
authors.affiliation: Department of Nephrology, The Second Affiliated Hospital of Nanchang University, 1, Minde Road, Nanchang, 330006, People's Republic of China. gaosixu@163.com.
authors.forename: Gaosi
authors.initials: G
authors.lastname: Xu
mesh_terms: D000111:Acetylcysteine / Q000009:adverse effects / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D002681:China; D018450:Disease Progression; D005067:Euthyroid Sick Syndromes / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D012307:Risk Factors; D016037:Single-Blind Method; D017693:Sodium Bicarbonate / Q000009:adverse effects / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D017693:Sodium Bicarbonate; D000111:Acetylcysteine
keywords: Chronic kidney disease; N-acetyl-cysteine; Non-thyroidal illness syndrome; Sodium bicarbonate