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Thyroid disease in end-stage renal disease

Rhee, Connie M.

Current Opinion in Nephrology and Hypertension: November 2019 - Volume 28 - Issue 6 - p 621–630
doi: 10.1097/MNH.0000000000000542
DIALYSIS AND TRANSPLANTATION: Edited by Anil Chandraker and J. Kevin Tucker
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Purpose of review Hypothyroidism is a highly prevalent endocrine disorder in the end-stage renal disease (ESRD) population, yet many cases may remain latent and undiagnosed.

Recent findings Epidemiologic data show that there is a nearly five-fold higher prevalence of hypothyroidism in advanced chronic kidney disease (CKD) patients vs. those without CKD. Given that the metabolism, degradation, and excretion of thyroid hormone and its metabolites, as well as the regulation of the hypothalamic–pituitary–thyroid axis may be altered in ESRD, certain considerations should be made when interpreting thyroid functional tests in these patients. Growing evidence shows that hypothyroidism and other thyroid functional test derangements are associated with higher risk of cardiovascular disease, worse patient-centered outcomes, and survival in the advanced CKD population, including those with ESRD. Although limited data examining treatment of hypothyroidism suggests benefit, further studies of the efficacy and safety of thyroid hormone supplementation, including clinical trials and rigorous longitudinal observational studies are needed to inform the management of thyroid dysfunction in CKD.

Summary Given the high burden of hypothyroidism in ESRD patients, and potential ill effects on their cardiovascular health, patient-centered outcomes, and survival, further research is needed to inform the optimal management of thyroid dysfunction in this population.

Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, California, USA

Correspondence to Connie M. Rhee, MD, MSc, Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine School of Medicine, 101 The City Drive South, City Tower, Suite 400, Orange, CA 92868, USA. Tel: +1 714 456 5142; fax: +1 714 456 6034; e-mail: crhee1@uci.edu

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