Treatment for non-thyroidal illness syndrome in advanced chronic kidney disease: a single-blind controlled study.

Abstract

Non-thyroidal illness syndrome (NTIS) is common among patients with advanced chronic kidney disease (CKD) and is strongly associated with poor prognosis. However, it remains unclear in how to correct this disorder and this study aimed to evaluate the effectiveness of sodium bicarbonate (SB) and N-acetyl-cysteine (NAC) for correcting NTIS status. Patients with CKD stage 3-4 were single-blind, placebo-controlled treated with placebo, SB, or NAC for 18weeks. The primary end points were the correction of NTIS and the occurrence of end-stage renal disease (ESRD). The secondary point was the change in estimated glomerular filtration rate (eGFR) after the follow-up. The Kaplan-Meier survival analysis showed significant lower correcting ratio of NTIS in control group compared with SB group [Hazard ratio (HR) 0.19, 95% confidence interval (CI) 0.04-0.89, p=0.035] and NAC group (HR 0.09, 95% CI 0.02-0.38, p=0.001), and increased ESRD risk in control group than in SB group (HR 1.97, 95% CI 1.02-3.84, p=0.045) and NAC group (HR 5.50, 95% CI 2.23-13.57, p<0.001). The Cox regression analysis demonstrated significantly different effectiveness of placebo, SB and NAC on NTIS correction and ESRD risk, p<0.05, respectively. Variance analysis displayed a greater reduction in eGFR in controls than in SB (p=0.044) and NAC group (p<0.001). SB and NAC are effective in promoting the recovery from NTIS status and delaying the deterioration of renal function in advanced CKD patients.