Thyroid Status and Death Risk in US Veterans With Chronic Kidney Disease

Connie M. Rhee, Kamyar Kalantar-Zadeh, Vanessa Ravel, Elani Streja, Amy S. You, Steven M. Brunelli, Danh V. Nguyen, Gregory A. Brent, Csaba Kovesdy

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objective: Given that patients with non–dialysis-dependent chronic kidney disease (NDD-CKD) have a disproportionately higher prevalence of hypothyroidism compared with their non-CKD counterparts, we sought to determine the association between thyroid status, defined by serum thyrotropin (TSH) levels, and mortality among a national cohort of patients with NDD-CKD. Patients and Methods: Among 227,422 US veterans with stage 3 NDD-CKD with 1 or more TSH measurements during the period October 1, 2004, to September 30, 2012, we first examined the association of thyroid status, defined by TSH categories of less than 0.5, 0.5 to 5.0 (euthyroidism), and more than 5.0 mIU/L, with all-cause mortality. We then evaluated 6 granular TSH categories: less than 0.1, 0.1 to less than 0.5, 0.5 to less than 3.0, 3.0 to 5.0, more than 5.0 to 10.0, and more than 10.0 mIU/L. We concurrently examined thyroid status, thyroid-modulating therapy, and mortality in sensitivity analyses. Results: In expanded case-mix adjusted Cox analyses, compared with euthyroidism, baseline and time-dependent TSH levels of more than 5.0 mIU/L were associated with higher mortality (adjusted hazard ratios [aHRs] [95% CI], 1.19 [1.15-1.24] and 1.23 [1.19-1.28], respectively), as were baseline and time-dependent TSH levels of less than 0.5 mIU/L (aHRs [95% CI], 1.18 [1.15-1.22] and 1.41 [1.37-1.45], respectively). Granular examination of thyroid status showed that incrementally higher TSH levels of 3.0 mIU/L or more were associated with increasingly higher mortality in baseline and time-dependent analyses, and TSH categories of less than 0.5 mIU/L were associated with higher mortality (reference, 0.5-<3.0 mIU/L) in baseline analyses. In time-dependent analyses, untreated and undertreated hypothyroidism and untreated hyperthyroidism were associated with higher mortality (reference, spontaneous euthyroidism), whereas hypothyroidism treated-to-target showed lower mortality. Conclusion: Among US veterans with NDD-CKD, high-normal TSH (≥3.0 mIU/L) and lower TSH (<0.5 mIU/L) levels were associated with higher death risk. Interventional studies identifying the target TSH range associated with the greatest survival in patients with NDD-CKD are warranted.

Original languageEnglish (US)
Pages (from-to)573-585
Number of pages13
JournalMayo Clinic Proceedings
Volume93
Issue number5
DOIs
StatePublished - May 1 2018

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Veterans
Chronic Renal Insufficiency
Thyroid Gland
Mortality
Hypothyroidism
Diagnosis-Related Groups
Thyrotropin
Hyperthyroidism
Survival
Serum

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Rhee, C. M., Kalantar-Zadeh, K., Ravel, V., Streja, E., You, A. S., Brunelli, S. M., ... Kovesdy, C. (2018). Thyroid Status and Death Risk in US Veterans With Chronic Kidney Disease. Mayo Clinic Proceedings, 93(5), 573-585. https://doi.org/10.1016/j.mayocp.2018.01.024

Thyroid Status and Death Risk in US Veterans With Chronic Kidney Disease. / Rhee, Connie M.; Kalantar-Zadeh, Kamyar; Ravel, Vanessa; Streja, Elani; You, Amy S.; Brunelli, Steven M.; Nguyen, Danh V.; Brent, Gregory A.; Kovesdy, Csaba.

In: Mayo Clinic Proceedings, Vol. 93, No. 5, 01.05.2018, p. 573-585.

Research output: Contribution to journalArticle

Rhee, CM, Kalantar-Zadeh, K, Ravel, V, Streja, E, You, AS, Brunelli, SM, Nguyen, DV, Brent, GA & Kovesdy, C 2018, 'Thyroid Status and Death Risk in US Veterans With Chronic Kidney Disease', Mayo Clinic Proceedings, vol. 93, no. 5, pp. 573-585. https://doi.org/10.1016/j.mayocp.2018.01.024
Rhee CM, Kalantar-Zadeh K, Ravel V, Streja E, You AS, Brunelli SM et al. Thyroid Status and Death Risk in US Veterans With Chronic Kidney Disease. Mayo Clinic Proceedings. 2018 May 1;93(5):573-585. https://doi.org/10.1016/j.mayocp.2018.01.024
Rhee, Connie M. ; Kalantar-Zadeh, Kamyar ; Ravel, Vanessa ; Streja, Elani ; You, Amy S. ; Brunelli, Steven M. ; Nguyen, Danh V. ; Brent, Gregory A. ; Kovesdy, Csaba. / Thyroid Status and Death Risk in US Veterans With Chronic Kidney Disease. In: Mayo Clinic Proceedings. 2018 ; Vol. 93, No. 5. pp. 573-585.
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abstract = "Objective: Given that patients with non–dialysis-dependent chronic kidney disease (NDD-CKD) have a disproportionately higher prevalence of hypothyroidism compared with their non-CKD counterparts, we sought to determine the association between thyroid status, defined by serum thyrotropin (TSH) levels, and mortality among a national cohort of patients with NDD-CKD. Patients and Methods: Among 227,422 US veterans with stage 3 NDD-CKD with 1 or more TSH measurements during the period October 1, 2004, to September 30, 2012, we first examined the association of thyroid status, defined by TSH categories of less than 0.5, 0.5 to 5.0 (euthyroidism), and more than 5.0 mIU/L, with all-cause mortality. We then evaluated 6 granular TSH categories: less than 0.1, 0.1 to less than 0.5, 0.5 to less than 3.0, 3.0 to 5.0, more than 5.0 to 10.0, and more than 10.0 mIU/L. We concurrently examined thyroid status, thyroid-modulating therapy, and mortality in sensitivity analyses. Results: In expanded case-mix adjusted Cox analyses, compared with euthyroidism, baseline and time-dependent TSH levels of more than 5.0 mIU/L were associated with higher mortality (adjusted hazard ratios [aHRs] [95{\%} CI], 1.19 [1.15-1.24] and 1.23 [1.19-1.28], respectively), as were baseline and time-dependent TSH levels of less than 0.5 mIU/L (aHRs [95{\%} CI], 1.18 [1.15-1.22] and 1.41 [1.37-1.45], respectively). Granular examination of thyroid status showed that incrementally higher TSH levels of 3.0 mIU/L or more were associated with increasingly higher mortality in baseline and time-dependent analyses, and TSH categories of less than 0.5 mIU/L were associated with higher mortality (reference, 0.5-<3.0 mIU/L) in baseline analyses. In time-dependent analyses, untreated and undertreated hypothyroidism and untreated hyperthyroidism were associated with higher mortality (reference, spontaneous euthyroidism), whereas hypothyroidism treated-to-target showed lower mortality. Conclusion: Among US veterans with NDD-CKD, high-normal TSH (≥3.0 mIU/L) and lower TSH (<0.5 mIU/L) levels were associated with higher death risk. Interventional studies identifying the target TSH range associated with the greatest survival in patients with NDD-CKD are warranted.",
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AU - Rhee, Connie M.

AU - Kalantar-Zadeh, Kamyar

AU - Ravel, Vanessa

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AU - You, Amy S.

AU - Brunelli, Steven M.

AU - Nguyen, Danh V.

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