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TSH levels affect mortality risk in hemodialysis
The risk for mortality was higher among adults undergoing hemodialysis who had high thyroid-stimulating hormone levels compared with those who had lower levels, study data show.
Connie M. Rhee, MD, MSc, of the Harold Simmons Center for Kidney Disease Research and Epidemiology, division of nephrology and hypertension at the University of California, Irvine Medical Center in Orange, California, evaluated data from the Hypothyroidism, Cardiovascular Health, and Survival (HyCARDS) study on 541 adults (mean age, 54 years) undergoing hemodialysis to determine the association between measures of serum TSH with mortality. Participants had their serum TSH levels measured every 6 months from May 2013 to August 2015. TSH levels were divided into three tertiles using observed baseline values: less than 1.28 mIU/L (tertile 1), 1.28 mIU/L to less than 2.14 mIU/L (tertile 2), and 2.14 mIU/L to 86.7 mIU/L (tertile 3).
At baseline, 3.3% of participants had hyperthyroidism, 86.1% had euthyroidism and 10.5% had hypothyroidism.
Through 817 patient-years of follow-up, 71 all-cause deaths occurred.
Compared with participants with TSH levels in the lowest tertile, participants with TSH levels in the highest tertile had a higher risk for mortality in the time-dependent analyses (HR = 2.54; 95% CI, 1.32-4.89).
A relationship also was found between the highest TSH tertile and higher mortality risk in an expanded case-mix, laboratory and medication analysis incrementally adjusted for thyroid hormone supplementation use (adjusted HR = 2.28; 95% CI, 1.45-3.58).
“Our study shows that TSH levels in the high-normal to high range are associated with short-term mortality risk in a prospective cohort of hemodialysis patients,” the researchers wrote. “Future studies are needed to confirm findings, determine the optimal target TSH range in dialysis patients, and define the underlying mechanisms by which high-normal and high TSH levels negatively impact survival in this population.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.