Thyroid failure in advanced chronic kidney disease: role of erythropoietin therapy

ABSTRACT

The recently described term [nonthyroidal illness syndrome] involve many organs including I he kidney, affection of which is usually associated with thyroid gland hypofunction. We studied the magnitude of thyroids hypofunction in patients with advanced chronic kidney disease [GFK <30 ml/min] before [N-60] and alter [N 60] dialysis compared to normal subjects. The effect of the commonly used erythropoietin for treatment of anemia in dialysis patients on thyroidal illness, was also studied [N 30], compared with non-Epo treated patients [N=30].We found that 21.66% of predialysis patients were hypothyroid, 69.23% of them were subclinical. Thyroidal illness [hypofunction] appeared to be increasing as severe as kidney function was deteriorating [GFR in euthyroid patients-18.44 +/- 7.18 compared in hypothyroid patients= 12.5 +/- 2.38. P<0.05]. 1n hemodialysis group, all cases [3.33% and 6.67% in subgroups ll a and b. resp.] had clinical hypothyroid ism. No relation was found between thyroid affection and the duration of hemodialysis [P>0.05]. Female gender, elderly patients and patients with type I. D.M. seemed to be more likely 10 be hypothyroid. Lastly, erythropoictin treated patients had a lesser likelihood to have their thyroid gland failed[2.65 +/- 1.96 and 3.17 +/- 2.56 for mean TSH [p<0.05], and 3,33%and6.67% for prevalence of hypothyroid ism in Epotreated and non-Epo treated groups resp.