Thyroid Function Test Derangements and Mortality in Dialysis Patients: A Systematic Review and Meta-analysis

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• 作者：Hong Xu ; MD¹ ; ² ; Nele Brusselaers ; MD ; PhD³ ; Bengt Lindholm ; MD ; PhD¹ ; ² ; Carmine Zoccali ; MD ; PhD⁴ ; Juan Jesú ; s Carrero ; PhD¹ ; ² ; ³ ; ^{juan.jesus.carrero@ki.se" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Thyroid disorders ; hypothyroidism ; triiodothyronine (T3) ; thyroxine (T4) ; hormones ; all-cause mortality ; cardiovascular mortality ; thyroid function test derangement ; haemodialysis ; peritoneal dialysis ; endocrine ; end-stage renal disease (ESRD) ; meta-analysis
• 刊名：American Journal of Kidney Diseases
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：68
• 期：6
• 页码：923-932
• 全文大小：438 K

文摘

We evaluated current evidence associating thyroid function test result derangements with risk for mortality in patients with chronic kidney failure treated by long-term dialysis.

Study Design

Systematic review and meta-analysis of cohort studies.

Setting & Population

Dialysis patients.

Selection Criteria for Studies

We searched PubMed, Web of Science, Science Citation Index, Cochrane Library, and Embase databases from inception through December 2015.

Predictors

Hypothyroidism (thyrotropin level greater than reference range) and low triiodothyronine (T₃) and thyroxine (T₄) levels.

Outcomes

All-cause and cardiovascular mortality.

Results

12 studies involving 14,766 participants (4,450 deaths) were identified. Of those, 6 studies provided data for cardiovascular mortality (2,772 participants with 327 cardiovascular deaths). Overall, confidence in the available evidence was moderate. Pooled adjusted HRs for all-cause mortality associated with hypothyroidism, low T₃ level, and low T₄ level were 1.24 (95% CI, 1.14-1.34), 1.67 (95% CI, 1.23-2.27), and 2.40 (95% CI, 1.47-3.93), respectively. Pooled adjusted HRs for cardiovascular mortality associated with low T₃ and T₄ levels were 1.84 (95% CI, 1.24-2.74) and 3.06 (95% CI, 1.29-7.24), respectively.

Limitations

Fewer studies reporting on T₄ and thyrotropin outcomes.

Conclusions

In patients treated with long-term dialysis, (cardiovascular) mortality is consistently higher in the presence of thyroid function test result derangements.