ABSTRACT
Chronic renal failure affects thyroid function in many ways. Disturbances in hemostasis and inflammation are common complications of kidney diseases. Endothelial dysfunction may link these two processes. The study was performed to assess thyroid hormones in relation to markers of endothelial damage and inflammation in hemodialyzed [HD] patients. Sixty patients on regular HD [40 patients treated with erythropoietin and 20 patients without erythropoietin therapy] and 30 healthy controls were studied. Thyroid hormones, markers of endotherlial damage [Von Willebrand factor [vWF], intracellular adhesion molecule [ICAM], marker of inflammation [high-sensitivity C-reactive protein [hsCRP] and tumor necrosis factor alpha [TNF alpha], hemostatic parameter [tissue plasminogen activator [tPA], kidney function tests, complete blood count, lipid profile, serum iron, serum albumin and total protein, serum calcium and phosphate were measured. The weekly erythropoietin dose and the patient demographics were recorded. Free T[3] were lower in HD patients compared with controls, markers of hemostasis, inflammation and endotherlial dysfunction were significantly higher in HD patients compared with controls. In all hemodialysis patients, free T[3] was independently related to time on dialysis, albumin, serum iron, total protein, triglycerides, total calcium, vWF, tPA and hsCRP. In the HD patients with CRP less than 6 mg/L, free T[3] was related to time on dialysis, total protein and triglycerides. While in HD patients with CRP greater than or equal to 6 mg/L, free T[3] was related to total calcium and hsCRP. Also in multiple regression analysis the predictors of free T[3] were hsCRP and dose of erythropoietin. We describe a novel relation between thyroid hormones and markers of endothelial dysfunction and inflammation in HD patients. Thyroid dysfunction is related to time on dialysis, endothelial damage, and inflammatory state, frequently encountered in uremia could be responsible for accelerated atherosclerosis and development of cardiovascular complications. Therefore, the relations between thyroid axis and endothelium in HD subjects merit additional studies