Prevalence Of Hypothyroidism in Esrd Patients with Maintenance Hemodialysis: Hypothyroidism in Esrd Patients with Maintenance Hemodialysis

Haseeb  Jameel Memon; Bhagwan  Das; Asma Naveed  Naveed; Rafia  Memon; Sughand  Memon; Santosh  Kumar

doi:10.54393/pbmj.v5i6.524

Authors

Haseeb Jameel Memon Liaquat University Hospital, Hyderabad
Bhagwan Das Liaquat University of Medical and Health Sciences, Jamshoro
Asma Naveed Naveed Bahria University of Medicine and Dental College (BUMMDC)
Rafia Memon Liaquat University of Medical and Health Sciences, Jamshoro
Sughand Memon Ziauddin University Hospital, Karachi
Santosh Kumar Jinnah Sindh Medical University, Karachi

DOI:

https://doi.org/10.54393/pbmj.v5i6.524

Keywords:

Hypothyroidism, End Stage Renal Disease, Hemodialysis

Abstract

The kidney affects “the thyroid gland causing various derangements in its function whenever the kidney is impaired, even with a minor imperfection in its job, and this makes dialysis patients more prone to thyroid disorders with subsequent increase in mortality and morbidity. Objective: To determine the frequency of hypothyroidism in ESRD patients who are on maintenance hemodialysis. Methods: A descriptive cross-sectional study was conducted at Department of Nephrology, Liaquat University of Medical and Health Sciences Jamshoro”, upon a sample of 140 patients having age between 18 to 70 years presented with end stage renal disease with 3 months or more of maintenance hemodialysis were consecutively enrolled. Investigations was advised for TSH levels, T3, T4. The presence of hypothyroidism along with baseline and clinical characteristics were noted. Results: Of 140 patients, the mean age of the sample was 62.31± 9.78 years. Majority of the sample were males as compared to females, i.e., 93 (66.4%) and 47 (33.6%). History of thyroid disorder was observed in 83 (59.3%) patients. Comorbidity showed that type 2 diabetes mellitus was observed in 65 (46.4%) and hypertension in 77 (55%) patients. The mean TSH, T3 and T4 level was found to be 4.67± 0.20, 0.97± 0.37, and 5.33± 0.69 respectively. Frequency of hypothyroidism was found to be 53 (37.9%) patients. Conclusion: A considerably higher number of patients were presented with hypothyroidism in “ESRD patients who are on maintenance hemodialysis.

References

Czarzasta K, Cudnoch-Jedrzejewska A, Niemczyk L, Wrzesien R, Tkaczyk M, Puchalska L, et al. Effect of chronic kidney disease on changes in vasopressin system expression in the kidney cortex in rats with nephrectomy. BioMed research international. 2018 Jun 14; 2018.doi.org/10.1155/2018/2607928.

Shaikh GM, Khan DA, Khan FA, Ali MK. Validation of modified estimated glomerular filtration rate in chronic kidney disease patients. J Coll Physicians Surg Pak. 2013 Nov;23(10):793-7.

Sharma K, Slawski B. renal disease and the surgical patient: Minimizing the impact. Cleve Clin J Med. 2018 Jul;85(7):559-67.doi.org/10.3949/ccjm.85a.17009

Anees M, Butt G, Gull S, Nazeer A, Hussain A, Ibrahim M. Factors affecting dermatological manifestations in patients with end- stage renal disease. J Coll Physicians Surg Pak. 2018 Feb;28(2):98-102. doi: 10.29271/jcpsp.2018.02.98.

Rhee CM, Zadeh KK, Ravel V, Streja E, You AS, Burnelli SM, et al. Thyroid status and death risk in U.S. veterans with chronic kidney disease. Mayo Clin Proc.2018 May;93(5):573-585.doi.org/10.1016/j.mayocp.2018.01.024

Bajaj S, Purwar N, Gupta A, Gupta P, sirivastava A. Prevalence of hypothyroidism in nondiabetic chronic kidney disease and effect of thyroxine replacement on estimated glomerular filtration rate. Indian J Nephrol. 2017 Mar-Apr; 27(2): 104-107.doi.org/10.4103/0971-4065.181464

Paudel K. Prevalence and clinical characteristics of hypothyroidism in a population undergoing maintenance hemodialysis. J ClinDiagn Res. 2014 Apr; 8(4): MC01-MC04.

doi.org/10.7860/JCDR/2014/7821.4246

You AS, Sin JJ, Kovesdy CP, Streja E, nguyen DV, Brent GA, et al. Association of thyroid status prior to transition to end stage renal disease with early dialysis mortality. Nephro dial transplant. 2018 oct 2018. doi.org/10.1093/ndt/gfy289

Jusufovic S, Hodzic E. Functional thyroid disorders are more common in patients on chronic hemodialysis compared with the general population. Mater Sociomed. 2011;23(4): 206-209.doi.org/10.5455/msm.2011.23.206-209

Rhee CM, Brent GA, Kovesdy CP, Soldin OP, Nguyen D, Budoff MJ, Brunelli SM, Kalantar-Zadeh K. Thyroid functional disease: an under-recognized cardiovascular risk factor in kidney disease patients. Nephrol Dial Transplant. 2015 May;30(5):724-37. doi: 10.1093/ndt/gfu024.

Pakfetrat M, Dabbaghmanesh MH, Karimi Z, Rasekhi A, Malekmakan L, Hossein Nikoo M. Prevalence of hypothyroidism and thyroid nodule in chronic hemodialysis Iranian patients. Hemodial Int. 2017 Jan;21(1):84-89. doi: 10.1111/hdi.12453.

Naseem F, Mannan A, Dhrolia MF, Imtiaz S, Qureshi R, Ahmed A. Prevalence of subclinical hypothyroidism in patients with chronic kidney disease on maintenance hemodialysis. Saudi J Kidney Dis Transpl. 2018 Jul-Aug;29(4):846-851. doi: 10.4103/1319-2442.239646.

Rhee CM, Kim S, Gillen DL, Oztan T, Wang J, Mehrotra R, et al. Association of thyroid functional disease with mortality in a national cohort of incident hemodialysis patients. J Clin Endocrinol Metab. 2015 Apr;100(4):1386-95. doi: 10.1210/jc.2014-4311.

Xu H, Brusselaers N, Lindholm B, Zoccali C, Carrero JJ. Thyroid Function Test Derangements and Mortality in Dialysis Patients: A Systematic Review and Meta-analysis. Am J Kidney Dis. 2016 Dec;68(6):923-932. doi: 10.1053/j.ajkd.2016.06.023.

Cuna V, Menghi V, Comai G, Cappuccilli M, Cianciolo G, Raimondi C, et al. Functional Abnormalities and Thyroid Nodules in Patients with End-stage Renal Disease. In Vivo. 2017 Nov-Dec;31(6):1203-1208. doi: 10.21873/invivo.11191.

Rhee CM, Chen Y, You AS, Brunelli SM, Kovesdy CP, Budoff MJ, et al. Thyroid Status, Quality of Life, and Mental Health in Patients on Hemodialysis. Clin J Am Soc Nephrol. 2017 Aug 7;12(8):1274-1283. doi: 10.2215/CJN.13211216.

Garber JR, Cobin RH, Gharib H, Hennessey JV, Klein I, Mechanick JI, et al. American Association of Clinical Endocrinologists and American Thyroid Association Taskforce on Hypothyroidism in Adults. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocr Pract. 2012 Nov-Dec;18(6):988-1028. doi: 10.4158/EP12280.GL.

Pearce SH, Brabant G, Duntas LH, Monzani F, Peeters RP, Razvi S, et al. 2013 ETA Guideline: Management of Subclinical Hypothyroidism. Eur Thyroid J. 2013 Dec;2(4):215-28. doi: 10.1159/000356507.

Amro N, Halahla A, Znaid I, Masalmah A. General assessment of thyroid stimulating hormone (TSH) levels among people living in south of Hebron, Palestine. International Journal of Information Research and Review. 2017; 4:4934-4937.

Shantha GP, Kumar AA, Bhise V, Khanna R, Sivagnanam K, Subramanian KK. Prevalence of Subclinical Hypothyroidism in Patients with End-Stage Renal Disease and the Role of Serum Albumin: A Cross-Sectional Study from South India. Cardiorenal Med. 2011;1(4):255-260. doi: 10.1159/000332757.

Rhee CM, Kim S, Gillen DL, Oztan T, Wang J, Mehrotra R, et al. Association of thyroid functional disease with mortality in a national cohort of incident hemodialysis patients. The Journal of Clinical Endocrinology & Metabolism. 2015 Apr 1;100(4): 1386-95.doi.org/10.1210/jc.2014-4311

Xu H, Brusselaers N, Lindholm B, Zoccali C, Carrero JJ. Thyroid function test derangements and mortality in dialysis patients: a systematic review and meta-analysis. American Journal of Kidney Diseases. 2016 Dec 1;68(6): 923-32.doi.org/10.1053/j.ajkd.2016.06.023