THYROID DYSFUNCTION IN PATIENTS WITH CHRONIC KIDNEY DISEASE

Abstract

It is known that patients with chronic kidney disease (CKD) often have hypothyroidism. In patients with CKD, iodine excretion in the urine is disrupted. The high content of iodine in the thyroid gland and tissues leads to a disruption in the synthesis and peripheral metabolism of thyroid hormones. In hypothyroidism, there is a disruption of sodium and water reabsorption in the proximal tubule, the volume of the filtrate increases, the volume of the tubular apparatus overloads, and the eGFR decreases.THЕAIM:to study the occurrence of hypothyroidism in patients with different stages of CKD, to evaluate the parameters of thyroid status and antithyroid antibodies in patients with CKD.PATIENTS AND METHODS.953 patients from I.P. Pavlov SPbSMU clinics (screening group) were examined. TSH, free T4, serum creatinine were defined and eGFR was calculated using the formula CKD-EPI in all patients. A group of patients with hypothyroidism accounted for 466 patients. Patients with a normal TSH of 0.4-2.5 mIU / L (comparison group) were selected from the screening group.RESULTS.eGFR in the screening group and in the group of hypothyroid patients correlated with age. Hypothyroidism was associated with female sex and older age. In the group of patients with advanced stage CKD (3B-5), the incidence of subclinical and manifest hypothyroidism was 3 times higher than in the group with normal GFR (GFR> 90 ml / min, p = 0.007). In the group of patients with hypothyroidism, the frequency of advanced stages of CKD (3B-5) was 2 times higher than in the comparison group (p = 0.02). In patients with CKD, a direct correlation was found between GFR and free T3 (r = 0.34, p = 0.02). Thyroid peroxidase antibodies were revealed in 64% of patients with CKD with hypothyroidism.CONCLUSION.Hypothyroidism is associated with chronic kidney disease. For patients with CKD, there is a syndrome of euthyroid pathology ("low T3" syndrome). Hypothyroidism in patients with CKD is not always the outcome of autoimmune thyroiditis.