DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20175513

Study of thyroid dysfunction and dyslipidemia in chronic kidney diseases

S. K. Tripathy, N. Dhal, M. Kanungo, S. Das, S. K. Mishra, Sai Swaroop, M. R. Behera, M. Panigrahi

Abstract


Background: Though there are many studies on thyroid dysfunction and dyslipidemia in Chronic Kidney Disease (CKD), no study is conclusive. Aim of this study was to correlate abnormalities in thyroid function and lipid profile with the severity of renal failure and also to observe the difference of these abnormalities between patients on conservative management verses hemodialysis.

Methods: Hundred consecutive CKD cases admitted to Medicine Department were taken up for the study. They were divided into two groups as Group-A [on conservative management] and Group-B [on regular Hemodialysis (HD)]. Hundred healthy persons were taken as control in Group-C. After evaluation of thyroid function and lipid profile statistical analysis was done by students t-test, chi-square and regression analysis.

Results: Hundred CKD cases with 74% male (n=74) and 26% female (n=26) in a M: F ratio of 2.9:1 were found to be in different stages CKD (0, 2, 20, 28 and 50 in stage-1 to stage-5 respectively). In 50 cases of stage-5 CKD, 30 were on HD and 20 on conservative management. Diabetes Mellitus (DM) (40%) was the commonest etiology of CKD followed by Hypertension (HTN), obstructive uropathy, chronic glomerulonephritis (CGN) and polycystic kidney disease (PKD). Thyromegaly was not found in a single case. In all CKD cases (Group-A+B) TT3 (TT3) was significantly low (P =0.0011) when compared with control (Group-C) and no difference was found between Group-A and Group-B. Fall in TT3 worsened with increasing severity of CKD. Lipid profile study revealed Decreased High-Density Lipoprotein Cholesterol (HDLc) and increased Triglyceride (TG), Total Cholesterol (TC), Low Density Lipoprotein Cholesterol (LDLc), TC/HDLc and LDLc/HDLc in Group-A than Group-B but only TG and TC increase was statistically significant. The levels of TG and TC and TC/HDLc increased as the stage of CKD progressed and was statistically significant (P= 0.035).

Conclusions: There occurs a state of biochemical hypothyroidism without overt clinical hypothyroid state in CKD, the extent of which correlates with the severity of CKD. Increased cardiovascular complications occur due to accelerated atherosclerosis in CKD. This study confirmed that atherogenic lipid profile and thyroid dysfunction worsen with the progression of disease. Difference between patients on conservative management and HD was not found.


Keywords


Biochemical hypothyroid state, Dyslipidemia, Hemodialysis, Thyroid function Test

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References


National KF. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification and stratification. American J Kidney Dis. 2002;39(2 suppl1):S1-266.

Kher V. End-stage renal disease in developing countries. Kidney international. 2002;62(1):350-62.

Thomas R, Kanso A, Sedor JR. Chronic kidney disease and its complications. Primary Care in office practice. 2008;35(2):329-44.

Silverberg DS, Ulan RA, Fawcett DM, Dossetor JB, Grace MDA, Beftcher K. Effects of chronic hemodialysis on thyroid function in chronic renal failure. Canad Medic Associ J. 1974;282-6.

Carter JN, Corcoran JM, Eastman CJ, Lazarus L. Effect of severe, chronic illness on thyroid function. Lancet. 1974;304(7887):971-4.

Gharib H, Ryan RJ, Mayberry WE, Hockert T. Radioimmunoassay for Triiodothyronine (T3): I. Affinity and Specificity of the Antibody for T3. J Clinic Endocrinol Met. 1971;33(3):509-16.

Spector DA, Davis PJ, Helderman JH, Bell BA, Utiger RD. Thyroid function and metabolic state in chronic renal failure. Ann Intern Med. 1976;85(6):724-30.

Ramirez G, O'Neill W, Jubiz W, Bloomer HA. Thyroid dysfunction in uremia: evidence for thyroid and hypophyseal abnormalities. Ann Int. Med. 1976;84(6):672-725.

Lim VS, Fang VS, Katz AL. Thyroid dysfunction in chronic renal failure-A study of pituitary thyroid axis and peripheral turn over kinetics of thyroxine and triiodothyronines. J Clinic Investig. 1977;60 (3):522-34.

Lim VS, Zavala DC, Flanigan MJ, Freeman RM. Blunted peripheral tissue responsiveness to thyroid hormone in uremic patients. Kidney Inter. 1987;31(3):808-14.

Foley RN, Parfrey PS, Sarnak MJ. Clinical epidemiology of cardiovascular disease in chronic renal disease. Ame J Kidney Dis. 1998;32:S112-9.

Attman PO, Samuelsson 0, Alaupovic P. Lipoprotein metabolism and renal failure, American J Kidney Dis. 1993;21:573-92.

Chen SC, Hung CC, Kuo MC, Lee JJ, Chiu YW, Chang JM, et al. Association of dyslipidemia with renal outcomes in chronic kidney disease. PLoS One. 2013;8(2):e55643.

Mehta HJ, Joseph LJ, Desai KB, Mehta MN, Samuel AM, Almeida AF, et al. Total and free thyroid hormone levels in chronic renal failure. J Postgraduate Medic. 1991;37(2):79.

Kaysen GA. Hyperlipidemia of chronic renal failure. Blood purification. 1994;12(1):60-7.

Kasiske BL. Hyperlipidemia in patients with chronic renal disease. Ame J kidney Dis 1998;32(5):S142-56.

Cheung AK, Wu LL, Kablitz C. Atherogenic lipids and lipoproteins in hemodialysis patients. Am J Kidney Dis. 1993;22(2):271-6.

Avram MM, Goldwasser P, Burrell DE. The uremic dyslipidemia: a cross sectional and longitudinal study. Ame J Kidney Dis. 1992;20(4):324-35.

Massy ZA, Khoa TN, Lacour B. Dyslipidemia and progression of renal disease in chronic renal failure patients. Nephrol Dialysis Transplantation. 1999;14:2392-7.