Prevalence and patterns of thyroid dyfunction in chronic kidney disease patients in a tertiary hospital in southern Nigeria
DOI:
https://doi.org/10.18203/2320-6012.ijrms20240502Keywords:
Chronic kidney disease, Dialysis naive, Thyroid dysfunction, University of Port HarcourtAbstract
Background: Several studies have identified that a decline in renal function as occurs in chronic kidney disease (CKD) is associated with thyroid dysfunction among other endocrine disorders. The prevalence and pattern of thyroid dysfunction in CKD patients in our environment is however not known. This study aimed to determine the prevalence and pattern of thyroid dysfunction in dialysis naïve CKD patients in a tertiary hospital in Southern Nigeria.
Methods: This was a cross sectional study involving 100 participants with established CKD and 100 age and sex matched healthy controls. Relevant data were collected using an interviewer based questionnaire. Samples collected from the participants were assayed for fT3, fT4, TSH and serum creatinine. Analyses was done using version 25 of the SPSS software at a 95% confidence interval and a p value of <0.05 was considered statistically significant.
Results: There were 93 males and 107 females with mean ages of 46.3±15.9 and 45.7±14.9 years for the CKD and control participants respectively (p=0.7587). The prevalence of thyroid dysfunction was 45% in the CKD group and 4% in the control group. Sick euthyroid syndrome was the commonest form of thyroid dysfunction (23%), followed by subclinical hypothyroidism (14%). Thyroid dysfunction increased with increasing severity of CKD but this was not statistically significant.
Conclusions: Thyroid dysfunction is highly prevalent in dialysis naive CKD patients. Further studies need to be carried out to determine risk factors and evaluate the impact of treatment in these patients following which a guideline for screening and management can be developed.
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References
Kasper DL, Hauser SL, Jameson LDJ, Fauci AS, Longo DL, Loscalzo J. Harrison Principle of Internal Medicine. 19th ed. New York: Mc Graw Hill Education; 2015.
Kumar R, Singh MP, Mehdi MD. Hospital based study on thyroid function in patients with Chronic Kidney Disease in Kosi region of Bihar. Int J Recent Sci Res. 2015;6(4):3412-5.
KDIGO. Clinical practice guideline update on diagnosis, evaluation, prevention and treatment of CKD-MBD, 2016. Available at: http:www.kdigo.org. Accessed 06 December 2019.
Couser WG, Remuzzi G, Mendis S, Tonelli M. The contribution of chronic kidney disease to the global burden of major noncommunicable diseases. Kidney Int. 2011;80 (10):1258-1270.
Neuen BL, Chadban SJ, Demaio AR, Johnson DW, Vlado Perkovic. Chronic kidney disease and the global NCDs agenda. BMJ Glob Heal. 2017;2.
Wang H, Naghavi M, Allen C, Barber RM, Carter A, Casey DC, et al. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: A systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:1459-1544.
Din UA, Salem MM, Abdulazim DO. Stop chronic kidney disease progression: Time is approaching. World J Nephrol. 2016;5(3):258.
Sharma P, McCullough K, Scotland G, McNamee P, Prescott G, MacLeod A, et al. Does stage-3 chronic kidney disease matter? A systematic literature review. Brit J Gene Pract. Royal Coll Gene Practition. 2010;60:266.
Kuczera P, Adamczak M, Wiecek A. Endocrine Abnormalities in Patients with Chronic Kidney Disease. Pril (Makedonska Akad na Nauk Umet Oddelenie za Med Nauk. 2015;36(2):109-18.
Niemczyk L, Romejko-ciepielewska K. Basic endocrinological disorders in chronic renal failure. Polish J Endocrinol. 2012;63(3):250-7.
Ros S, Carrero JJ. Endocrine alterations and cardiovascular risk in CKD: Is there a link? Nefrologia. 2013;33:181-7.
Iglesias P, Díez JJ. Thyroid dysfunction and kidney disease. Eur J Endocrinol. 2009;160(4):503-15.
Punekar J, Singh AA, Malav MK. Study of thyroid function in patients with chronic kidney disease. Int J Heal Sci Res Int J Heal Sci Res. 2017;7(2):68.
Ahmed MM. Association of renal failure with thyroid dysfunction: a retrospective cohort study. Saudi J Kidney Dis Transpl. 2014;25(5):1017-25.
Chandra A. Prevalence of hypothyroidism in patients with chronic kidney disease: a cross-sectional study from North India. Kidney Res Clin Pract. 2016;35(3):165-8.
Kaggia SNN. Thyroid hormone profiles in patients with chronic kidney disease at Kenyatta National Hospital. Nairobi Kenya. A dissertation submitted to the University of Nairobi in part fulfilment of the requirements for Degree of Masters of Medicine in Human Physiology 2013. Available at: http://erepository.uonbi.ac.ke/handle/11295/52526. Accessed 10 October 2017.
Da Costa ABBA, Pellizzari C, Carvalho GA, Sant’Anna BC, Montenegro RL, Zammar Filho RG, et al. High prevalence of subclinical hypothyroidism and nodular thyroid disease in patients on hemodialysis. Hemodial Int. 2016;20(1):31-7.
Mohamedali M, Reddy MS, Vyas A, Iyer V, Cheriyath P. Thyroid disorders and chronic kidney disease. Int J Nephrol. 2014;2014.
Tatar E, Kircelli F, Ok E. The contribution of thyroid dysfunction on cardiovascular disease in patients with chronic kidney disease. Atheroscler. 2013;227(1):26-31.
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;100(4):1386-95.
Allawi AA. Prevalence of hypothyroidism in chronic kidney disease among sample of Iraqi Patients. J Fac Med Baghdad. 2013;55(2):97-101.
Okaka EI Ayinbuomwan E. Thyroid profile in nondialysis-dependent patients with chronic kidney disease in a tertiary hospital in southern Nigeria. J Med Trop. 2018;20(1):57-62.
Du X, Pan B, Li W, Zou Y, Hua X, Huang W, et al. Albuminuria is an independent risk factor of T4 elevation in chronic kidney disease. Sci Rep. 2017;7:41302.
Rhee CM, Kalantar-Zadeh K, Streja E, Carrero JJ, Ma JZ, Lu JL, et al. The relationship between thyroid function and estimated glomerular filtration rate in patients with chronic kidney disease. Nephrol Dial Transplant. 2015;30(2):282-7.
Swaminathan K, Rajesh S, Avudaiappan S. A study of thyroid function abnormalities in patients with chronic kidney disease. IOSR J Dent. 2016;15(8):7-15.
Dednam M. The interpretation and management of thyroid disorders. J Endocrinol Diabetes South Africa. 2015;20(2):4-9.
Ndu VO, Wokoma FS. Prevalence and pattern of mineral bone disease in patients with Chronic Kidney Disease in Port harcourt. Int J Adv Nephrol Res. 2019;2(1):1-8.
Odum E, Udi E. Evaluation of cardiovascular risk factors in patients with chronic kidney disease. Port Harcourt Med J. 2017;11(2):60-6.
Adejumo O, Akinbodewa A, Okaka E, Alli O, Ibukun I. Chronic kidney disease in Nigeria: late presentation is still the norm. Niger Med J. 2016;57(3):185.
Amoako YA, Laryea DO, Bedu-Addo G, Andoh H, Awuku YA. Clinical and demographic characteristics of chronic kidney disease patients in a tertiary facility in Ghana. Pan Afr Med J. 2014;18:274.
Keunmoe P, Halle MP, Clement J, Nguedia A, Jelil A, Tengen JF, et al. The spectrum of thyroid function abnormalities and associated biochemical factors in patients with chronic kidney disease in Cameroon. Am J Biochem Sci Res. 2020;961:387-96.
Roderick P, Roth M, Mindell J. Prevalence of chronic kidney disease in England: Findings from the 2009 Health Survey for England. J Epidemiol Community Heal. 2011;65(Suppl 2):12.
Carrero JJ, Hecking M, Chesnaye NC, Jager KJ. Sex and gender disparities in the epidemiology and outcomes of chronic kidney disease. Nature Revi Nephrol. 2018;14:151-64.
Kannan A, Sriramakrishnan V, Kannan B, Anandan H. Thyroid function abnormalities in patients with chronic kidney disease -A prospective study. Int J Sci Study. 2017;5(4):68-72.
Eun OK, Ihn SL, Yoo AC, Sang JL, Yoon KC, Hye EY et al. Unresolved subclinical hypothyroidism is independently associated with progression of chronic kidney disease. Int J Med Sci. 2014;11(1):52-9.
Sinha V, Kumar A, Kachhawa P, Agrawal S. Thyroid dysfunction and dyslipidemia in patients with chronic kidney diseases. Int J Med Sci Public Heal. 2016;5(12):2597-2603.
Pan B, Du X, Zhang H, Hua X, Wan X, Cao C. Relationships of chronic kidney disease and thyroid dysfunction in non-dialysis patients : a pilot study. Kidney Blood Press Res. 2019;44:170-8.
Kim YA, Park YJ. Prevalence and risk factors of subclinical thyroid disease. Endocrinol Metab. 2014;29(1):20-9.
Nair CG, Jacob P, Menon R, Babu MJ. Graves’ disease in a dialysis dependent chronic renal failure patient. Indian J Nephrol. 2014;24(6):397-9.
Zhang Y, Wang Y, Tao XJ, Li Q, Li FF, Lee KO et al. Relationship between thyroid function and kidney function in patients with type 2 diabetes. Int J Endocrinol. 2018;2018:1-7.