Journal
CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY
Volume 12, Issue 8, Pages 1274-1283Publisher
AMER SOC NEPHROLOGY
DOI: 10.2215/CJN.13211216
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Funding
- National Institutes of Health (NIH) / National Institute of Diabetes and Digestive and Kidney Diseases [K23-DK102903]
- American Thyroid Association [R01-DK092232, K24-DK091419]
- National Center for Advancing Translational Sciences, NIH, through the University of California Irvine Biostatistics, Epidemiology and Research Design Unit [UL1 TR001414]
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Background and objectives In the general population, there is increasing recognition of the effect of thyroid function on patient-centered outcomes, including health-related quality of life and depression. Although hypothyroidism is highly prevalent in hemodialysis patients, it is unknown whether thyroid status is a risk factor for impaired health-related quality of life or mental health in this population. Design, setting, participants, & measurements We examined the association of thyroid status, defined by serum thyrotropin, with health-related quality of life and depressive symptoms over time in a prospective cohort of 450 patients on hemodialysis from 17 outpatient dialysis facilities from May of 2013 to May of 2015 who underwent protocolized thyrotropin testing, Short-Form 36 surveys, and Beck Depression Inventory-II questionnaires every 6 months. We examined the association of baseline and time-dependent thyrotropin categorized as tertiles and continuous variables with eight Short-Form 36 domains and Beck Depression Inventory-II scores using expanded case mix plus laboratory adjusted linear mixed effects models. Results In categorical analyses, the highest baseline thyrotropin tertile was associated with a five-point lower Short-Form 36 domain score for energy/fatigue (P=0.04); the highest time-dependent tertile was associated with a five-point lower physical function score (P=0.03; reference: lowest tertile). In continuous analyses, higher baseline serum thyrotropin levels (+Delta 1 mIU/L) were associated with lower role limitations due to physical health (beta=-1.3; P=0.04), energy/fatigue (beta=-0.8; P=0.03), and pain scores (beta=-1.4; P=0.002), equivalent to five-, three-, and five point lower scores, respectively, for every 1-SD higher thyrotropin. Higher time-dependent thyrotropin levels were associated with lower role limitations due to physical health scores (beta=-1.0; P=0.03), equivalent to a three-point decline for every 1-SD higher thyrotropin. Baseline and time-dependent thyrotropin were not associated with Beck Depression Inventory-II scores. Conclusions In patients on hemodialysis, higher serum thyrotropin levels are associated with impaired health related quality of life across energy/fatigue, physical function, and pain domains. Studies are needed to determine if thyroid-modulating therapy improves the health-related quality of life of hemodialysis patients with thyroid dysfunction.
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