Subclinical Hypothyroidism in Advanced Chronic Kidney Disease Patients: Prevalence and Associated Factors

Javier Reque Santivañez; Beatriz Garcia Peris; Nayara Panizo Gonzalez; Alejandro Perez Alba; Luis D'Marco; Eládio Collado Boira

doi:10.1155/2022/1077553

Subclinical Hypothyroidism in Advanced Chronic Kidney Disease Patients: Prevalence and Associated Factors

J Thyroid Res. 2022 May 17:2022:1077553. doi: 10.1155/2022/1077553. eCollection 2022.

Authors

Javier Reque Santivañez¹, Beatriz Garcia Peris¹, Nayara Panizo Gonzalez², Alejandro Perez Alba¹, Luis D'Marco³, Eládio Collado Boira⁴

Affiliations

¹ Hospital General Universitario de Castellón, Nephrology Department, Valencia, Spain.
² Hospital Clínico Universitario de Valencia, INCLIVA, Nephrology Department, Valencia, Spain.
³ Departamento de Medicina y Cirugía, Facultad Ciencias de la Salud, Universidad Cardenal Herrera-CEU, Alfara del Patriarca, Spain.
⁴ Universidad Jaime I Castellón, Valencia, Spain.

Abstract

Introduction: Renal function and thyroid metabolism are tightly related. However, evidence about subclinical hypothyroidism prevalence in patients with chronic kidney disease and its related factors is scarce.

Objectives: Our aim is to analyze subclinical hypothyroidism prevalence and its related factors in patients with advanced chronic kidney disease. Materials and methods. Nondialysis-dependent patients with chronic kidney disease at stages 3 to 5 were included. Other inclusion criteria were age above 18 years and clinical stability. Patients with diagnosed thyroid illnesses were excluded. Subclinical hypothyroidism was defined as thyroid stimulating hormone (TSH) > 5.3 mU/L, with free thyroxine 4 (FT4) between 0.54 and 1.24 ng/dl. Filiation data, comorbidities, and routine blood and urine test results were registered.

Results: A total of 299 patients were included. Of them, 184 (61.5%) were men. The mean age was 71 ± 13 years old. The mean glomerular filtration rate (CKD-EPI) was 22 ± 9 ml/min/1.73 m². According to chronic kidney disease stages, global distribution of patients was as follows: Stage 3, 67 patients (22.4%); Stage 4, 155 patients (51.8%); and Stage 5, 77 patients (25.8%). We found subclinical hypothyroidism in 54 (18.1%) patients. According to chronic kidney disease stages, distribution of affected patients was as follows: Stage 3, 9 patients (13%); Stage 4, 25 patients (16.1%); and Stage 5, 20 patients (26%). Differences among stages were statistically significant. By univariate analysis, factors related with subclinical hypothyroidism were as follows: age RR 1.048 (95% CI 1.019-1.078; p=0.001), hypertension RR 2.705 (95% CI 1.026-7.130; p=0.04), glomerular filtration rate RR 0.962 (95% CI 0.929-0.996; p=0.03), and proteinuria higher than 1 gram/day RR 2.387 (95% CI 1.303-4.374; p=0.005). By multivariate analysis adjusted by age, hypertension, glomerular filtration rate, proteinuria, diabetes, and cardiovascular disease history, only age RR 1.016 (95% CI 1.009-1.028; p=0.04) and glomerular filtration rate RR 0.963 (95% CI 0.930-0.997; p=0.03) preserved their independent association with subclinical hypothyroidism.

Conclusions: Subclinical hypothyroidism prevalence in patients with chronic kidney disease is high and increases with renal disease severity. Factors independently related to subclinical hypothyroidism are age and glomerular filtration rate.