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논문분류	춘계학술대회 초록집
제목	Association of Thyroid Status Prior To Transition to End-Stage Renal Disease with Early Dialysis Mortality
저자	Amy You1, John Sim2, Csaba Kovesdy3, Elani Streja1, Danh Nguyen1, Gregory Brent4, Kamyar Kalantar-Zadeh1, Connie Rhee1
출판정보	2018; 2018(1):
키워드	Thyroid \| Hypothyroid \| Mortality \| Dialysis \| Transition
초록	Objectives: Advanced chronic kidney disease (CKD) patients, including those receiving dialysis, have a high prevalence of thyroid dysfunction. Whereas hypothyroidism is associated with higher death risk in end-stage renal disease (ESRD) patients, no studies have examined whether thyroid status in the pre-ESRD period impacts mortality after dialysis initiation. Methods: Among US Veterans transitioning to dialysis over 10/2007-9/2011, we examined the association of pre-ESRD serum thyrotropin (TSH) levels averaged over the one-year pre-dialysis (“prelude”) period with all-cause mortality in the first year following dialysis initiation using survival models. Results: Among 15,335 patients in the one-year prelude cohort, TSH levels >5.0mIU/L were associated with higher mortality in expanded case-mix Cox models (reference: TSH 0.5-<3.0mIU/L): adjusted HR (aHR) (95%CI) 1.18 (1.05-1.31). Similar findings were observed for TSH levels >5.0mIU/L and mortality in the two-year and five-year cohorts: aHRs (95%CI) 1.10 (1.01-1.20) and 1.13 (1.05-1.22), respectively. Analyses of finer gradations of TSH in the one-year prelude cohort demonstrated that incrementally higher levels >5.0mIU/L were associated with increasingly higher mortality in expanded case-mix models (reference: TSH 0.5-3.0mIU/L): aHRs (95%CI) 1.16 (1.02-1.31) and 1.27 (1.02-1.58) for TSH levels >5.0-10.0mIU/L and >10.0mIU/L, respectively. In the two-year and five-year cohorts, the mortality associations persisted most strongly for those with TSH >10.0mIU/L, particularly after laboratory covariate adjustment. Conclusions: Among new ESRD patients, there is a dose-dependent relationship between higher pre-ESRD TSH levels >5.0mIU/L and post-ESRD mortality. Further studies are needed to determine the impact of TSH reduction with thyroid hormone supplementation on outcomes in this population. Thyroid Status and Mortality Risk
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