Association between Hypothyroidism and Chronic Kidney Disease in Patients with Type 2 Diabetes Mellitus in Saudi Community b based Hospital- A Retrospective Single Centre Study

Abstract

Background and objective: The association between type 2 diabetes (T2DM) complicated with chronic kidney disease (CKD) and hypothyroidisms were not well studied. To estimate retrospectively the prevalence of hypothyroidism in patients with T2DM complicated with CKD in Saudi community based hospital. Design: We analyzed retrospectively 1364 participants with T2DM whom are between the ages 20 to 96 years. All patients were from the population of the Primary health centre at King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia. All data were collected on the basis of a review of electronic medical data. Patients with Thyrotropin level (TSH) above the normal range of TSH for our laboratory reference, history of hypothyroidism and taking thyroid replacement therapy were included. Patient who are pregnant were excluded. All patients in the present study fulfilled the revised National Kidney Foundation criteria for the diagnosis of CKD. Results: Out of 1286 subjects with T2DM, there were 346 cases (26.9%) male and 940 cases (73.1%) were female with mean age 55.4±12.3 and body mass index 31.8±6.3 kg/m2. There were 53 cases (4.1%), 736 cases (57.2%) and 346 cases (26.9%) with CKD, hypertension and hypothyroidism respectively. The mean TSH and FT4 value was 4.2±8.0 mIU/l and 15.1±2.9 pmol/l respectively. Among cases of T2DM and CKD, there were 21 cases (39.6 %) with hypothyroidism, p=0.04. Regression analysis of odd ratio of risk factors for patients with T2DM and CKD with hypothyroidism showed that male gender, age, presence of hypothyroidism and HbA1c were associated with higher likely hood of CKD, (OR=11.5; 95% confidence interval [CI]=5.2, 25.6), p<0.0001), (OR=1.1; 95% CI=1.04, 1.1), p=0.004), (OR=4.4; 95% CI=2.1, 9.1), p<0.0001) and (OR=1.2; 95% CI=1.04, 1.4), p=0.01) respectively. Hypothyroidism with CKD was more prevalent in the seventh decade (17%). Prevalence of hypothyroidism was more prevalent across all age groups and significantly more prevalent in males as compared to females in the sixth (1.7% vs. 0.3%) and seventh (0.9% vs. 0.2%) decades. Conclusion: We conclude that despite the limitations of this hospital-based retrospective study, hypothyroidism is highly prevalent in cohort of Saudis with CKD and T2DM. The majority of our patients with primary hypothyroidism in our finding were predominantly males. These two observations remain to be validated by population-based studies. In the absence of registry data, larger cooperative studies involving diverse population samples from multiple centers could help to provide further information on the true frequency nationally