Low thyroid function is not associated with an accelerated deterioration in renal function
Low thyroid function is not associated with an accelerated deterioration in renal function
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DOI：
10.1093/ndt/gfy071
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发表时间：
2019-04-01
影响因子：
6.1
通讯作者：
den Elzen, Wendy P. J.
中科院分区：
文献类型：
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作者：
Meuwese, Christiaan L.;van Diepen, Merel;den Elzen, Wendy P. J.
背景 慢性肾脏病（CKD）经常伴有甲状腺激素功能障碍。目前尚不清楚这些改变是 CKD 的原因还是结果。本研究旨在通过横断面和纵向分析研究甲状腺激素变化对所有成人年龄组个体肾功能的影响。方法纳入了来自 16 个独立队列的个体参与者数据 (IPD)，这些数据测量了促甲状腺激素、游离甲状腺素水平和肌酐水平。使用临床临界值来定义甲状腺激素状态。估计肾小球滤过率（eGFR）通过肾病饮食四变量修正（MDRD）公式计算。对于此 IPD 荟萃分析，通过分别拟合每个队列中的线性回归模型和线性混合模型来计算基线的 eGFR 和随访期间的 eGFR 变化。使用随机效应模型汇总效应估计值。 结果 总共纳入了来自 16 个不同队列的 72856 名个体。基线时，与甲状腺功能正常的受试者 (n=66542) 相比，患有明显甲状腺功能减退症 (n=704) 和亚临床甲状腺功能减退症 (n=3356) 的个体的 eGFR 平均（95% 置信区间）为 -4.07（-6.37 至 -1.78）和 -2.40（-3.78 至 -1.02）mL/min/1.73m(2)。在（亚临床）甲状腺功能亢进受试者 (n=2254) 中，平均 eGFR 升高 3.01 (1.50-4.52) mL/min/1.73m(2)。在 329713 个患者年的随访中，与甲状腺功能正常的个体相比，甲状腺功能低下的个体 eGFR 并未下降得更快。 结论 甲状腺功能低下与肾功能恶化无关。这种横断面关联可以用肾功能障碍导致甲状腺激素改变来解释。
Background Chronic kidney disease (CKD) is frequently accompanied by thyroid hormone dysfunction. It is currently unclear whether these alterations are the cause or consequence of CKD. This study aimed at studying the effect of thyroid hormone alterations on renal function in cross-sectional and longitudinal analyses in individuals from all adult age groups.Methods Individual participant data (IPD) from 16 independent cohorts having measured thyroid stimulating hormone, free thyroxine levels and creatinine levels were included. Thyroid hormone status was defined using clinical cut-off values. Estimated glomerular filtration rates (eGFR) were calculated by means of the four-variable Modification of Diet in Renal Disease (MDRD) formula. For this IPD meta-analysis, eGFR at baseline and eGFR change during follow-up were computed by fitting linear regression models and linear mixed models in each cohort separately. Effect estimates were pooled using random effects models.Results A total of 72856 individuals from 16 different cohorts were included. At baseline, individuals with overt hypothyroidism (n=704) and subclinical hypothyroidism (n=3356) had a average (95% confidence interval) -4.07 (-6.37 to -1.78) and -2.40 (-3.78 to -1.02) mL/min/1.73m(2) lower eGFR as compared with euthyroid subjects (n=66542). In (subclinical) hyperthyroid subjects (n=2254), average eGFR was 3.01 (1.50-4.52) mL/min/1.73m(2) higher. During 329713 patient years of follow-up, eGFR did not decline more rapidly in individuals with low thyroid function compared with individuals with normal thyroid function.Conclusions Low thyroid function is not associated with a deterioration of renal function. The cross-sectional association may be explained by renal dysfunction causing thyroid hormone alterations.