title: Hypothyroidism is associated with all-cause mortality in a national cohort of chronic haemodialysis patients.
abstract: OBJECTIVE
  The prevalence of hypothyroidism is high in haemodialysis (HD) patients and hypothyroidism increases all-cause mortality in HD patients. Comorbidities are common in HD patients and are associated with both mortality and hypothyroidism. The aim of the study is to explore the effect of the interactions of comorbidities and hypothyroidism on all-cause mortality in HD patients.
  
  
  METHODS
  Patients with hypothyroidism (ICD-9-CM 244.0, 244.1, and 244.9) and matched patients without hypothyroidism in the Registry for Catastrophic Illness Patient Database of Taiwan Health Insurance from 2000 to 2010 were analyzed. The association of hypothyroidism and risk of all-cause mortality was analyzed using Cox proportional hazard regression.
  
  
  RESULTS
  Nine hundred and eight HD patients with hypothyroidism and 3632 sex-, age-, gender- matched HD patients without hypothyroidism were analyzed. Hypothyroidism was associated with increased all-cause mortality with an adjusted hazard ratio of 1.22 [95% confidence interval (CI): 1.10-1.36, P < 0.001]. TRT may decrease mortality associated with hypothyroidism (P < 0.001). There was a significant interaction (P = 0.04) between diabetes and hypothyroidism. There was no significant interaction found in hypothyroidism and the following comorbidities: hyperlipidaemia, hypertension, chronic obstructive pulmonary disease, coronary artery disease, stroke, peripheral arterial disease, asthma, congestive heart failure and cancer.
  
  
  CONCLUSIONS
  Hypothyroidism is associated with increased all-cause mortality in chronic HD patients. The interaction of hypothyroidism and diabetes, but not other common comorbidities in HD patients, has an effect on mortality risks.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Asia University Hospital, Wufeng, Taichung, Taiwan.|Kidney Institute and Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Wufeng, Taichung, Taiwan.
authors.forename: Hsuan-Jen
authors.initials: HJ
authors.lastname: Lin
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Asia University Hospital, Wufeng, Taichung, Taiwan.
authors.forename: Chung-Chih
authors.initials: CC
authors.lastname: Lin
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Tainan Municipal Annan Hospital- China Medical University, Wufeng, Taichung, Taiwan.
authors.forename: Hsuan Ming
authors.initials: HM
authors.lastname: Lin
authors.affiliation: Management Office for Health Data, China Medical University Hospital, Wufeng, Taichung, Taiwan.|College of Medicine, China Medical University, Wufeng, Taichung, Taiwan.
authors.forename: Hsuan-Ju
authors.initials: HJ
authors.lastname: Chen
authors.affiliation: Management Office for Health Data, China Medical University Hospital, Wufeng, Taichung, Taiwan.|College of Medicine, China Medical University, Wufeng, Taichung, Taiwan.|Healthcare Service Research Center (HSRC), Taichung Veterans General Hospital, Wufeng, Taichung, Taiwan.
authors.forename: Che-Chen
authors.initials: CC
authors.lastname: Lin
authors.affiliation: Kidney Institute and Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Wufeng, Taichung, Taiwan.|College of Medicine, China Medical University, Wufeng, Taichung, Taiwan.
authors.forename: Chiz-Tzung
authors.initials: CT
authors.lastname: Chang
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Asia University Hospital, Wufeng, Taichung, Taiwan.|Kidney Institute and Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Wufeng, Taichung, Taiwan.|College of Medicine, China Medical University, Wufeng, Taichung, Taiwan.|Department of Biotechnology, Asia University, Wufeng, Taichung, Taiwan.
authors.forename: Che-Yi
authors.identifier: http://orcid.org/0000-0003-4029-9097
authors.initials: CY
authors.lastname: Chou
authors.affiliation: Kidney Institute and Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Wufeng, Taichung, Taiwan.|College of Medicine, China Medical University, Wufeng, Taichung, Taiwan.
authors.forename: Chiu-Ching
authors.initials: CC
authors.lastname: Huang
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D015897:Comorbidity; D016208:Databases, Factual; D003920:Diabetes Mellitus / Q000401:mortality; D005260:Female; D006801:Humans; D007037:Hypothyroidism / Q000175:diagnosis / Q000401:mortality*; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: ESRD; Hypothyroidism; haemodialysis