title: Association of TSH Elevation with All-Cause Mortality in Elderly Patients with Chronic Kidney Disease.
abstract: Chronic kidney disease (CKD) is a widespread condition in the global population and is more common in the elderly. Thyroid-stimulating hormone (TSH) level increases with aging, and hypothyroidism is highly prevalent in CKD patients. However, the relationship between low thyroid function and mortality in CKD patients is unclear. Therefore, we conducted a retrospective cohort study to examine the relationship between TSH elevation and all-cause mortality in elderly patients with CKD. This retrospective cohort study included individuals ≥65 years old with CKD (n = 23,786) in Taipei City. Health examination data from 2005 to 2010 were provided by the Taipei Databank for Public Health Analysis. Subjects were categorized according to thyroid-stimulating hormone (TSH) level as follows: low normal (0.34<TSH<1.074 mIU/L), middle normal (1.074≤TSH≤2.46 mIU/L), high normal (2.46<TSH<5.2 mIU/L), elevated I (5.2≤TSH<10 mIU/L), and elevated II (TSH≥10 mIU/L). Risk of mortality was evaluated using a Cox proportional hazard regression model adjusted for sex, age, hypertension, diabetes mellitus, CKD stage, serum albumin, high-density lipoprotein cholesterol, uric acid, hemoglobin, body mass index, glutamic-pyruvic transaminase, smoking, alcohol consumption, and history of cardiovascular disease (coronary artery disease, congestive heart failure, cerebral vascular disease), history of cancer, and history of chronic obstructive pulmonary disease. Our results showed that compared to the reference group (middle normal TSH), the risk of all-cause mortality was increased in the elevated I group (hazard ratio [HR], 1.21; 95% confidence interval [CI], 1.02-1.45) and elevated II group (HR, 1.30; 95% CI, 1.00-1.69). We found a significant association between TSH elevation and all-cause mortality in this cohort of elderly persons with CKD. However, determining the benefit of treatment for moderately elevated TSH level (5.2-10 mIU/L) in elderly patients with CKD will require a well-designed randomized controlled trial.
authors.affiliation: Division of Family Medicine, Department of Community Medicine, Taipei City Hospital, Taipei, Taiwan.|Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Mei-Hsing
authors.initials: MH
authors.lastname: Chuang
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei City Hospital, Taipei, Taiwan.
authors.forename: Kuo-Meng
authors.initials: KM
authors.lastname: Liao
authors.affiliation: Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.|Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Yao-Min
authors.initials: YM
authors.lastname: Hung
authors.affiliation: Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan.|Department of Education and Research, Taipei City Hospital, Taipei, Taiwan.
authors.forename: Yi-Chang
authors.initials: YC
authors.lastname: Chou
authors.affiliation: Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Pesus
authors.initials: P
authors.lastname: Chou
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000378:metabolism; D005260:Female; D006801:Humans; D008297:Male; D009026:Mortality; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D051436:Renal Insufficiency, Chronic / Q000097:blood*; D012189:Retrospective Studies; D012306:Risk; D013624:Taiwan; D013972:Thyrotropin / Q000097:blood*
chemical_list: D013972:Thyrotropin