Abstract
Background: Chronic Kidney Disease is a worldwide health problem with an increasing incidence and prevalence. Abnormalities in the structure and function of the thyroid gland and in the metabolism and plasma concentration of thyroid hormones are common in patients with Chronic Kidney Disease. In view of variability of thyroid function tests in patients with CKD in previous studies, a prospective study of various thyroid functions is undertaken to establish a correlation if any between thyroid dysfunction and severity of renal diseases.
Method: Total number of 100 patients with Chronic Kidney Disease on conservative management who were admitted in MMCHRI was selected in this prospective study.
Results: Out of the 100 patients with CKD 48 patients had low T3 syndrome (0.2-1.9ng/ml, mean 0.605) which accounts for 48% of the patients, 22 patients had low T4 syndrome (0.5-9.5μg/ml, mean 5.631) which accounts for 22% of the patients and 10 patients had primary hypothyroidism TSH >20μIU/ml. Excluding Primary Hypothyroidism, analysis of serum T3,T4 and TSH in the study subjects shows very high significance, p < 0.001. Distribution of Thyroid. Dysfunction in this study among various creatinine clearance levels showed that as glomerular filtration rate declines, number of patients with low T3 syndrome increased, p < 0.05, significant difference. In patients with low T3 syndrome, the mean values of TSH in various stages of renal disease are within normal range mean 4.85, values of TSH did not show any linear correlation with GFR. Number of patients with low T4 syndrome did not correlate with severity of renal disease.
Conclusion: Thyroid Dysfunction occurred in 58% of the patients with chronic kidney disease in our study, it does not indicate a state of hypothyroidism, but a reflection of the state of chronic illness/malnutrition. The low T3 state of CKD can be
viewed as being protective, promoting conservation of protein. The number of patient with low T3 syndrome progressively increase with the severity of renal failure.
Keywords: Chronic Kidney Disease, glomerular filtration rate, End stage renal disease, Thyroid dysfunction
References
- Andrew S. Levey, Josef Coresh, Ethan Balk, Annamaria Kausz, Ronald D. Perrone. National Kidney Foundation Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratifi-cation. MD Ann Intern Med.2003;139:137-147.
- Christopher PJ, Selvaraj S, Brinda, et al. A population-based study on chronic kidney disease in Kanyakumari Government Medical College. J. Evid. Based Med. Healthc. 2016; 3(97), 5358-5360
- Ajay Kumar Katiyar, S. K. Katiyar. “Study of Lipid Profile and Homocysteine Levels in Cases of Chronic Kidney Disease”. Journal of Evolution of Medical and Dental Sciences 2014; Vol. 3, Issue 26, June 30; Page: 7135-7142.
- Kaptein EM, Quion-Verde H, Chooljian CJ, Tang WW, Friedman PE, Rodriquez HJ et al. The thyroid in end stage renal disease, Medicine (Baltimore) 1988; 67:187- 97.
- Lakshmi Keerthana, Anil Kumar. Study of Thyroid and Lipid Profile in Chronic Kidney Disease. International Journal of Medical and Health Research, 2016,2; 3; Page No. 06-09
- Kaptein E et The Thyroid in end stage renal diseases, Medicine, 1988; 67:187-97.
- Jha V, Garcia-Garcia G, Iseki K. Chronic kidney disease: global dimension and perspectives. Lancet Jul 20 2013; 382(9888):260-272.
- Gattineni J, Sas D, Dagan, Baum MG, Effect of thyroid hormone on the postnatal renal expression of NHE8, American Journal of Physiology, Renal Physiology, 2008; 294:198-204.
- Malyszko J, Malyszko J, Wolczynski S, Mysliwiec M. Adiponectin, leptin and thyroid hormones in patients with chronic renal failure and on renal replacement therapy: are they related? Nephrol Dial Transplant. 2006; 21(1):145–52.
- Bakris GL., Ritz E., Hypertension and kidney disease. A marriage that should be prevented. Kidney Int 2009; 75: 449-452.
- Pakhle K, Parikh R, Jain A, Kashyap P, Dave D, Bhate A. Thyroid dysfunctions in patients with chronic renal failure. Int J Res Med Sci 2017;5:2773-8.
- Mohamedali M, Maddika SR, Vyas A, Iyer V, Cheriyath P. Thyroid disorders and chronic kidney disease. Int J Nephrol. 2014;2014:1-6.
- Gopalan Senthilnathan, Raman Prabhakaran. A Study of Evaluation of Thyroid Function Status In Patients With Chronic Kidney Disease. IOSR Journal of Dental and Medical Sciences, 2017; 16(6) ver. IX, 103-106.
- Avasthi G, Malhotra S, Narang APS, Sengupta S. Study of thyroid function on patients of chronic renal failure. Indian J Nephrol. 2001;11:165-9.
- Shamsuddin M, Baig MSA, Hemalatha , Kumari S. Thyroid dysfunctions in patients with chronic renal failure. Int J Biol Med Res. 2014; 5(1): 3911-3914.
- Ramirez G et Thyroid abnormalities in renal failure. A study of 53 patients on chronic dialysis. Ann Internal Medicine, 1973; 79, 500-4.
- Gattineni J, Sas D, Dagan, Baum MG, Effect of thyroid hormone on the postnatal renal expression of NHE8, American Journal of Physiology, Renal Physiology, 2008; 294:198-204.
Corresponding Author
Dr Kirubakaran S
Assistant Professor, Aarupadai Veedu Medical College, Pondicherry
Phone: 9791797372, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.