Chronic Kidney Disease and Thyroid Hormones.

Hypothyroidism was present in 7.4% and hyperthyroidism in 6.0% of CKD patients in this cohort, with the majority (86.6%) having normal thyroid function.

• Total cohort included 30,804 CKD patients enrolled in the China Renal Data System.
• 26,673 patients (86.6%) had normal thyroid function.
• 2,291 patients (7.4%) had hypothyroidism.
• 1,840 patients (6.0%) had hyperthyroidism.
• Study design was a retrospective cohort study.

Hypothyroidism independently predicted an increased risk of renal failure in CKD patients.

• Adjusted HR = 1.29 (95% CI, 1.15–1.45; P < .001) for composite renal failure.
• Analysis used multivariable Cox proportional hazards regression models with adjustment for relevant clinical and demographic covariates.
• The primary endpoint was composite renal failure.
• Kaplan-Meier survival analyses were also conducted.

Both hypothyroidism and hyperthyroidism were independently associated with increased all-cause mortality in CKD patients.

• Hypothyroidism was associated with increased all-cause mortality: adjusted HR = 1.24 (95% CI, 1.11–1.39; P < .001).
• Hyperthyroidism was also associated with increased all-cause mortality: adjusted HR = 1.20 (95% CI, 1.07–1.33; P < .01).
• All-cause mortality was a primary endpoint of the study.
• Associations were adjusted for relevant clinical and demographic covariates.

Thyroid hormone replacement therapy (THRT) was associated with a significantly reduced risk of renal failure in hypothyroid CKD patients.

• THRT was associated with an adjusted HR of 0.65 (95% CI, 0.52–0.82; P < .001) for renal failure.
• This represents a approximately 35% reduction in the risk of renal failure associated with THRT.
• The impact of THRT on renal outcomes was a secondary endpoint of the study.
• Analysis was restricted to hypothyroid patients within the cohort.

The authors recommend regular thyroid function monitoring and appropriate THRT as considerations in CKD management.

• Thyroid dysfunction (both hypo- and hyperthyroidism) is described as prevalent in CKD patients and as significantly impacting renal outcomes and mortality.
• THRT is stated to 'appear to attenuate the adverse effects of hypothyroidism on renal function.'
• The recommendation is based on findings from 30,804 CKD patients in the China Renal Data System.