Thyroid hormones associate with risk of incident chronic kidney disease and rapid decline in renal function: a prospective investigation.
Thyroid hormones associate with risk of incident chronic kidney disease and rapid decline in renal function: a prospective investigation.
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甲状腺激素与慢性肾病和肾功能快速下降的风险相关：一项前瞻性调查
DOI：
10.1186/s12967-016-1081-8
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发表时间：
2016-12-03
影响因子：
7.4
通讯作者：
Xu M
中科院分区：
文献类型：
--
作者：
Huang X;Ding L;Peng K;Lin L;Wang T;Zhao Z;Xu Y;Lu J;Chen Y;Wang W;Bi Y;Ning G;Xu M
在横断面研究中，甲状腺激素与肾功能障碍有关。然而，探索甲状腺激素对肾功能下降影响的前瞻性研究很少，且结果相互矛盾。我们旨在前瞻性地探究甲状腺激素与中国成年人慢性肾脏病（CKD）发病以及估算肾小球滤过率（eGFR）快速下降之间的关联。
参与者来自一个社区队列，包括2103名年龄在40岁及以上且基线时无CKD的个体。在基线时通过放射免疫分析法测量促甲状腺激素（TSH）、游离三碘甲状腺原氨酸（FT3）和游离甲状腺素（FT4）。在基线和随访时测量血清肌酐、尿肌酐和白蛋白。CKD定义为eGFR<60 ml/min/1.73 m²或尿白蛋白/肌酐比值≥30 mg/g。eGFR快速下降定义为每年eGFR下降>3 ml/min/1.73 m²。
在4年的随访期间，198名参与者发生了CKD，165名经历了eGFR快速下降。在校正混杂因素后，与第1三分位数相比，FT4水平处于第3三分位数与CKD发病风险增加1.88倍（95%置信区间[CI]，1.27 - 2.77）相关，与eGFR快速下降风险增加1.64倍（95% CI，1.07 - 2.50）相关（两者趋势P值均≤0.02）。FT4每升高1 pmol/L，CKD发病风险增加12%，eGFR快速下降风险增加10%。在发生CKD的个体中，FT4与CKD并发并发症及进一步结局的较高风险显著相关。我们未发现FT3或TSH与CKD或eGFR快速下降存在关联。
在中国中老年人中，较高的FT4（而非TSH和FT3）与CKD发病及eGFR快速下降的风险增加有关。
BackgroundThyroid hormones have been associated with renal dysfunction in cross-sectional studies. However, prospective studies exploring the effect of thyroid hormones on renal function decline were sparse and got contradictive results. We aimed to prospectively explore the associations of thyroid hormones with incident chronic kidney disease (CKD) and rapid decline in estimated glomerular filtration rate (eGFR) in Chinese adults.MethodsThe participants were from a community-based cohort including 2103 individuals aged 40 years or above without CKD at baseline. Thyroid-stimulating hormone (TSH), free triiodothyronine (FT3) and free thyroxin (FT4) were measured by radioimmunoassay at baseline. Serum creatinine, urinary creatinine and albumin were measured at baseline and follow-up. CKD was defined as eGFR <60 ml/min/1.73 m2or urinary albumin-to-creatinine ratio ≥30 mg/g. Rapid eGFR decline was defined as an annual eGFR decline >3 ml/min/1.73 m2.ResultsDuring 4 years of follow-up, 198 participants developed CKD and 165 experienced rapid eGFR decline. Compared to tertile 1, tertile 3 of FT4 levels were associated with 1.88-folds (95% confidence interval [CI], 1.27–2.77) increased risk of incident CKD; and 1.64-folds (95% CI, 1.07–2.50) increased risk of rapid eGFR decline (bothPfor trend ≤0.02), after adjustment for confounders. Each 1-pmol/l of FT4 was associated with 12% increased risk of incident CKD and 10% of rapid eGFR decline. Among the incident CKD individuals, FT4 was significantly associated with higher risk of concurrent complications and further outcomes of CKD. We did not find associations of FT3 or TSH with CKD or rapid eGFR decline.ConclusionsHigher FT4, but not TSH and FT3, was associated with increased risk of incident CKD and rapid eGFR decline in middle-aged and elderly Chinese.
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影响因子：
13.6
作者：
Perkins, Bruce A.;Ficociello, Linda H.;Krolewski, Andrzej S.
通讯作者：
Krolewski, Andrzej S.
影响因子：
13.2
作者：
Collins, Allan J.;Foley, Robert N.;Agodoa, Lawrence
通讯作者：
Agodoa, Lawrence
影响因子：
5.8
作者：
Bremner, Alexandra P.;Feddema, Peter;Walsh, John P.
通讯作者：
Walsh, John P.
影响因子：
120.7
作者：
Hallan, Stein I.;Matsushita, Kunihiro;Sang, Yingying;Mahmoodi, Bakhtawar K.;Black, Corri;Ishani, Areef;Kleefstra, Nanne;Naimark, David;Roderick, Paul;Tonelli, Marcello;Wetzels, Jack F. M.;Astor, Brad C.;Gansevoort, Ron T.;Levin, Adeera;Wen, Chi-Pang;Coresh, Josef
通讯作者：
Coresh, Josef
影响因子：
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作者：
Basu G;Mohapatra A
通讯作者：
Mohapatra A