Thyroid Function Test Derangements and Mortality in Dialysis Patients: A Systematic Review and Meta-analysis.
BACKGROUND
We evaluated current evidence associating thyroid function test result derangements with risk for mortality in patients with chronic kidney failure treated by long-term dialysis.


METHODS
Systematic review and meta-analysis of cohort studies.


METHODS
Dialysis patients.


METHODS
We searched PubMed, Web of Science, Science Citation Index, Cochrane Library, and Embase databases from inception through December 2015.


METHODS
Hypothyroidism (thyrotropin level greater than reference range) and low triiodothyronine (T3) and thyroxine (T4) levels.


RESULTS
All-cause and cardiovascular mortality.


RESULTS
12 studies involving 14,766 participants (4,450 deaths) were identified. Of those, 6 studies provided data for cardiovascular mortality (2,772 participants with 327 cardiovascular deaths). Overall, confidence in the available evidence was moderate. Pooled adjusted HRs for all-cause mortality associated with hypothyroidism, low T3level, and low T4level were 1.24 (95% CI, 1.14-1.34), 1.67 (95% CI, 1.23-2.27), and 2.40 (95% CI, 1.47-3.93), respectively. Pooled adjusted HRs for cardiovascular mortality associated with low T3and T4levels were 1.84 (95% CI, 1.24-2.74) and 3.06 (95% CI, 1.29-7.24), respectively.


CONCLUSIONS
Fewer studies reporting on T4and thyrotropin outcomes.


CONCLUSIONS
In patients treated with long-term dialysis, (cardiovascular) mortality is consistently higher in the presence of thyroid function test result derangements.
Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Division of Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
Hong
H
Xu
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Nele
N
Brusselaers
Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Division of Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
Bengt
B
Lindholm
Division of Nephrology, Dialysis and Kidney Transplantation, CNR Hospital, Reggio Calabria, Italy.
Carmine
C
Zoccali
Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Division of Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. Electronic address: juan.jesus.carrero@ki.se.
Juan Jesús
JJ
Carrero
D015331:Cohort Studies; D006801:Humans; D006435:Renal Dialysis / Q000401:mortality*; D013959:Thyroid Diseases / Q000503:physiopathology*; D013960:Thyroid Function Tests; D013961:Thyroid Gland / Q000503:physiopathology*
Thyroid disorders; all-cause mortality; cardiovascular mortality; end-stage renal disease (ESRD); endocrine; haemodialysis; hormones; hypothyroidism; meta-analysis; peritoneal dialysis; thyroid function test derangement; thyroxine (T(4)); triiodothyronine (T(3))