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. 2022;12(3):106-116.
doi: 10.1159/000525037. Epub 2022 May 12.

Serum Thyrotropin Elevation and Coronary Artery Calcification in Hemodialysis Patients

Connie M Rhee  1 , Matthew Budoff  2 , Gregory Brent  3   4 , Amy S You  1 , Peter Stenvinkel  5 , Alejandra Novoa  1 , Ferdinand Flores  2 , Sajad Hamal  2 , Christopher Dailing  2 , April Kinninger  2 , Tracy Nakata  1 , Csaba P Kovesdy  6   7 , Danh V Nguyen  8 , Kamyar Kalantar-Zadeh  1   9
Affiliations

Serum Thyrotropin Elevation and Coronary Artery Calcification in Hemodialysis Patients

Connie M Rhee et al. Cardiorenal Med. 2022.

Abstract

Introduction: Hypothyroidism is highly prevalent in end-stage kidney disease patients, and emerging data show that lower circulating thyroid hormone levels lead to downregulation of vascular calcification inhibitors and coronary artery calcification (CAC) in this population. To date, no studies have examined the association of serum thyrotropin (TSH), the most sensitive and specific single biochemical metric of thyroid function, with CAC risk in hemodialysis patients.

Methods: In secondary analyses of patients from the Anti-Inflammatory and Anti-Oxidative Nutrition in Hypoalbuminemic Dialysis Patients trial, we examined serum TSH levels and CAC risk assessed by cardiac computed tomography scans collected within a 90-day period. We evaluated the relationship between serum TSH with CAC Volume (VS) and Agatston score (AS) (defined as >100 mm3 and >100 Houndsfield Units, respectively) using multivariable logistic regression.

Results: Among 104 patients who met eligibility criteria, higher TSH levels in the highest tertile were associated with moderately elevated CAC VS and AS in case-mix-adjusted analyses (ref: lowest tertile): adjusted ORs (95% CIs) 4.26 (1.18, 15.40) and 5.53 (1.44, 21.30), respectively. TSH levels >3.0 mIU/L (ref: ≤3.0 mIU/L) were also associated with moderately elevated CAC VS and AS. In secondary analyses, point estimates of incrementally lower direct free thyroxine levels trended toward elevated CAC VS and AS, although associations did not achieve statistical significance.

Conclusions: In hemodialysis patients, higher serum TSH was associated with elevated CAC VS and AS. Further studies are needed to determine if thyroid hormone supplementation can attenuate CAC burden in this population.

Keywords: Calcification; Dialysis; End-stage kidney disease; Thyroid; Thyrotropin.

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Conflict of interest statement

Conflicts of Interest:

None of the authors have any relevant disclosures to report.

Figures

Figure 1.
Figure 1.. Study cohort creation.
Abbrev.: AIONID, Anti-Inflammatory and Anti-Oxidative Nutrition in Hypoalbuminemic Dialysis Patients; CAC, coronary artery calcification; anti-TPO antibody, anti-thyroid peroxidase antibody; FT4, free thyroxine.
Figure 2.
Figure 2.
Association between serum thyrotropin (TSH) category and total Volume Score (VS) using logistic regression in unadjusted (Panel A), case-mix (Panel B), expanded case-mix (Panel C), and expanded case-mix+vascular access (Panel D) models.
Figure 3.
Figure 3.
Association between serum thyrotropin (TSH) category and total Agatston Score (AS) using logistic regression in unadjusted (Panel A), case-mix (Panel B), expanded case-mix (Panel C), and expanded case-mix+vascular access (Panel D) models.
See this image and copyright information in PMC

References

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