Abstract
Purpose To determine if the TSH is related to estimated glomerular filtration rate (eGFR) in T2D patients without overt thyroid dysfunction. Methods A cohort study of 5936 T2D patients was assessed for thyroid and kidney functions, in whom 248 with subclinical hyperthyroidism and 362 with subclinical hypothyroidism. Serum creatinine and 24-hour urine albumin excretion (UAE) were collected. Chronic kidney disease (CKD) was defined as eGFR < 60 ml/min/1.73 m2. Results Compared with euthyroid subjects, the patients with subclinical hypothyroidism had lower eGFR (82.7 ± 22.4 vs. 90.5 ± 22.4 ml/min/1.73 m2, p < 0.01), higher UAE (114 ± 278 vs. 88 ± 229 mg/24 h, p < 0.05), and high incidence of CKD (16.0% vs. 10.1%, p < 0.05). The participants with a TSH level between 0.55 and 3.0 μIU/ml had a higher eGFR (91.4 ± 22.2 ml/min/1.73 m2) and a lower prevalence of CKD (9.5%) than those with higher TSH (3.01–4.78 μIU/ml, 85.6 ± 22.7 ml/min/1.73 m2, p < 0.01 and 13.1%, p < 0.01). Linear logistic regression analysis showed that the eGFR was significantly negatively associated with TSH (OR: 0.519, 95% CI: 0.291–0.927, p < 0.05), after adjustment of confounders. Conclusion High TSH was independently associated with decreased eGFR in type 2 diabetes patients without overt thyroid dysfunction. Our findings indicate that doctors who treat T2D patients should routinely measure the thyroid function.
Highlights
Many patients with T2D develop chronic kidney disease, which is defined based on glomerular filtration rate < 60 ml/ min/1.73 m2 and/or the presence of albuminuria, as defined in the recommendations of the 2012 KDIGO practice guideline [1]
Some studies have shown that overt and subclinical hypothyroidisms were associated with reduced estimated glomerular filtration rate (eGFR) and increased risk of Chronic kidney disease (CKD) [8,9,10,11] and that unresolved subclinical hypothyroidism was independently associated with the rate of renal function decline [12]
Despite overt thyroid disease being uncommon in type 2 diabetic patients, there is an increase in subclinical hypothyroidism in these patients when compared with healthy population [13], but it is not known if the change in eGFR and CKD in these patients with T2D is related to thyroid function, especially in patients within the normal range of TSH
Summary
Many patients with T2D develop chronic kidney disease, which is defined based on glomerular filtration rate < 60 ml/ min/1.73 m2 and/or the presence of albuminuria, as defined in the recommendations of the 2012 KDIGO practice guideline [1]. Some studies have shown that overt and subclinical hypothyroidisms were associated with reduced eGFR and increased risk of CKD [8,9,10,11] and that unresolved subclinical hypothyroidism was independently associated with the rate of renal function decline [12]. Despite overt thyroid disease being uncommon in type 2 diabetic patients, there is an increase in subclinical hypothyroidism in these patients when compared with healthy population [13], but it is not known if the change in eGFR and CKD in these patients with T2D is related to thyroid function, especially in patients within the normal range of TSH. We assessed the association of thyroid function with eGFR, 24-hour urine albumin excretion (UAE), and CKD in a large cross-sectional population study of type 2 diabetic participants without overt thyroid dysfunction
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