The effect of thyroxin tablet on thyroid hormone level changes in patients with chronic kidney disease

Objective To investigate the occurrence of thyroid disorders in septic patients and the relationship between thyroid hormone level and the change of left ventricular function.Methods A total of 63 septic patients,43 male and 20 female,aged 50 to 88 years with mean 63.3 ± 18.5,were included in the present study.The thyroid hormone levels and C-reactive protein (CRP) levels were detected in all patients on the next day of admission.Clinical information of each patient was recorded including demographics and co-existed disease,APACHE Ⅱ score at admission and the incidence of shock and subsequent multiple organ dysfunction syndrome (MODS).At 24 hours,the second week and the third week after admission,a serial trans-thoracic echocardiography were performed in all patients to observe changes of left ventricular end diastolic dimension,left ventricular eject fraction and E/A (the ratio between maximal velocity of blood flow at mitral valve orifice in the early diastolic phase and maximal velocity of blood flow of atrium in systolic phase).Another 38 patients with ordinary infections,21 male and 17 female,with mean age 58.6 ± 16.8 (48-84 years) were selected as controls for comparison.The difference in thyroid function between sepsis group and control group was analyzed.The levels of serum thyroid hormone associated with the incidence of shock and MODS were studied among different types of the left ventricular structure and function in sepsis group.Results The levels of serum free tri-iodothyronine (FT3) and free tetra-iodothyronine (FT4) in sepsis group were significantly lower than those in control group (P ＜ 0.05),but there was no difference in level of thyroid stimulating hormone (TSH) between these two groups.The patients with sepsis had three types of the left ventricular dysfunction:diastolic dysfunction without the enlargement of left ventricular (type Ⅰ) in 31 patients,the enlargement of left ventricular with diastolic dysfunction (type Ⅱ) in 18 patients and the enlargement of left ventricular with both systolic and diastolic dysfunction (type Ⅲ) in 14 patients.Compared with the other two types,the type Ⅲ patients had significantly lower levels of FT3 and FT4 and higher incidences of shock and MODS (P ＜ 0.05).No significant difference in TSH level was found among the three types.There were no significantly differences in FT3 and FT4 between type Ⅰ and type Ⅱ,but the higher incidences of shock and MODS were found in type Ⅰ (P ＞ 0.05).Conclusions Most septic patients have thyroid function disorder.Serum thyroid hormone levels in early stage of sepsis have certain role in predicting changes in left ventricular structure and function in the late stage of disease. Key words: Sepsis ; Left ventrieular; Echocardiography; Thyroxin; C-reactive protein

Heart failure (HF) is a major public health and economic problem in Western countries and is one of the most common causes of hospitalization and death. Coronary artery disease is the underlying cause in more than two thirds of chronic HF patients. By 2020, the World Health Organization projects that ischemic heart disease alone will be the most important global cause of morbidity and mortality. The estimated increases in HF-related morbidity and mortality suggest that our understanding of the pathophysiological mechanisms of this syndrome is inadequate. Interest in the role of thyroid hormones (THs) in HF has increased in recent years. The driving considerations can be summarized as follows: (1) the known effects of THs on contractile and relaxation properties of the heart; (2) experimental findings offering strong support for the hypothesis that TH signaling is critical in preserving cardiac structure and performance under normal conditions and after cardiac injury; and (3) evidence that mildly altered TH function is strongly associated with a worsening prognosis in cardiac patients in general and in HF patients in particular. Diastolic function and systolic function are clearly influenced by THs.1 Ventricular contractile function is also influenced by changes in hemodynamic conditions secondary to TH effects on peripheral vascular tone.1 TH homeostasis preserves positive ventricular-arterial coupling, leading to a favorable balance for cardiac work. A study in rats demonstrated that chronic hypothyroidism alone can eventually lead to HF.2 Other studies suggest reduced cardiac tissue triiodothyronine (T3) levels after myocardial infarction (MI) or with development of hypertension by upregulating type 3 deiodinase (D3), which leads to deactivation of T3 and T4 (thyroxine).3–6 This review highlights a growing body of evidence from animal studies and small-scale clinical trials suggesting that low cellular thyroid activity at the cardiac tissue level may adversely affect HF …

Echocardiography to predict adverse cardiac and vascular events in patients with severe chronic kidney disease (stage 4): A prospective study

Antidepressant-Resistant Depression in Patients With Comorbid Subclinical Hypothyroidism or High-Normal TSH Levels.

Vitamin D supplementation may have beneficial effects on cardiovascular outcomes in patients with chronic kidney disease (CKD), but the underlying data are conflicting. We conducted a meta-analysis to investigate the effect of vitamin D on cardiovascular outcomes in patients with CKD.We searched MEDLINE (via PubMed), the Cochrane Library, Scopus, and ClinicalTrials.gov from inception to 16 March 2024 for all randomized controlled trials (RCTs) assessing vitamin D supplementation in patients with CKD and reporting cardiovascular outcomes. Our primary outcomes were the incidence of adverse cardiovascular events and the change in left ventricular ejection fraction (LVEF) and left ventricular mass index (LVMI). Our secondary outcomes were the change in systolic blood pressure (SBP) and diastolic blood pressure (DBP). Data were pooled using risk ratio (RR) and mean difference as the effect measures.A total of 11 RCTs were included in our review. Vitamin D supplementation reduced the risk of adverse cardiovascular events in patients with CKD (RR 0.39; 95% CI 0.22 to 0.69; I2=0). There was no significant difference in LVEF, LVMI, SBP, and DBP between the vitamin D and control groups.Vitamin D supplementation does not affect adverse cardiovascular events, LVEF, LVMI, SBP, and DBP. Further large-scale RCTs and mechanistic studies are needed to understand the potential benefits of vitamin D supplementation in this patient population.

Evolution of Echocardiographic Measures of Cardiac Disease From CKD to ESRD and Risk of All-Cause Mortality: Findings From the CRIC Study

Aims. Patients with diabetic nephropathy are reported to have a high prevalence of leftventricular structural and functional abnormalities. This study was designed to assessthe determinants of left ventricular mass index (LVMI) and left ventricular ejectionfraction (LVEF) in diabetic patients at various stages of chronic kidney disease(CKD). Methods. This cross-sectional study enrolled 285 diabetic patients with CKD stages 3to 5 from our outpatient department of internal medicine. Clinical andechocardiographic parameters were compared and analyzed. Results. We found a significant stepwise increase in LVMI (P < 0.001), LVH (P < 0.001), and LVEF <55% (P = 0.013) and a stepwise decrease in LVEF (P = 0.038)corresponding to advance in CKD stages. Conclusions. Our findings suggest that increases in LVMI and decreases in LVEF coincidewith advances in CKD stages in patients with diabetes.

Research Highlights

Objectives To investigate the relationship between serum thyroid hormone in patients with chronic renal failure and albuminuria,which can provide an objective basis for the clinicians in the diagnosis and treatment of chronic kidney disease.Methods The serum samples of patients with chronic kidney disease group were collected and tested in Nanjing first hospital and then statistical analyzed.The clinical characteristics consisted of 5 items of thyroid hormone (thyrotropin,total T3,free T3,total T4 and free T4) were recorded.Different albuminuria groups were set through the level of albuminuria according to the KDIGO guideline.Results Total T4 and free T4 were significantly different in ACR ＜30mg/g,30-300mg/g and ＞300mg/g (both P =0.000).Positive relationship between T4、FT4 、T3、FT3 and albuminuria were found through correlation analysis (Pearson correlation coefficient were 0.243,0.230,0.209 and 0.138 respectively,with P =0.000).Conclusions T4、FT4 were positively correlated with albuminuria. Key words: Kidney Disease; Albuminuria; Thyroid Hormone

Objective Monitoring the thyroid hormone levels in patients before and after renal transplantation to realize the relationship between thyroid hormones and renal function.Methods Fifty-seven patients were subdivided into stabled graft function group (50 cases) and delayed graft function (DGF) group (7 cases).Thirty healthy men served as control group.Serum triiodothyronine (T3),thyroxine (T4),thyroid-stimulating hormone (TSH) and serum creatinine (Scr) were determined respectably before transplantation and on different days after transplantation.Correlations between thyroid hormones and Scr at 10th day after transplantation were analyzed.Results Serum T3 and T4 levels before transplantation in the two groups were significantly lower than those in the control group (P＜0.01).These four parameters levels had no significant difference between stabled graft function group and DGF group (P＞0.05).In stabled graft function group:T3 level was decreased obviously by 30％ in the 1st day after transplantation,which was higher than the others,elevated at the 1st week post-transplantation,reached the normal range.at the 2nd week post-operation,and higher than pre-transplantation (P ＜ 0.01) at 3rd week; T4 revealed a decrease trend after transplantation and was elevated at 10th day post-transplantation,returned to the pre-transplantation level at 3rd week; TSH had slight decrease after operation,and had no significant difference among every period in comparing with pre-transplantation; Scr revealed a decrease trend continuously and returned to the normal level at the 7th day post-transplantation.In DGF group,Hormones levels were obviously decreased as compared with stabled graft function group; T3 reached the normal range at the 3rd week post-transplantation,whereas T4 returned to pre-transplantation levels at the 30th day; TSH had a significant decrease at the 5th day,and began to increase at the 10th day post-operation; Scr retuned to the normal range at the 30th day post-operation.The correlation coefficients between Scr and T3,T4 were 0.546 and 0.423 respectively.Conclusion There is a significant correlation between thyroid hormones and renal function (T3,T4).Monitoring the thyroid hormones,specially T3,can diagnose renal function change. Key words: Triiodothyronine; Thyroxine; Kidney transplantation; Inosine

Increased left ventricular (LV) mass is a predictor of heart failure (HF). The preventive effect of sodium-glucose cotransporter 2 inhibitors remains unclear in subjects without HF. The aim of this study was to evaluate the effect of empagliflozin on LV mass index (LVMI) and LV volumes in individuals with overweight and considered at risk of HF. An investigator-initiated, double-blinded, randomized, placebo-controlled, multicenter superiority trial [NCT05084235] comprised 191 older adult (60-84 years), overweight (body mass index [BMI] >28 kg/m2) individuals with at least 1 known risk factor for HF (hypertension, ischemic heart disease, stroke, chronic kidney disease). Study participants were randomized 1:1 to empagliflozin 10 mg or matching placebo for 180 days. Individuals with HF or type 2 diabetes were excluded. The primary endpoint was change in LVMI from baseline to 180 days assessed by cardiac magnetic resonance imaging, with between-group comparisons expressed as adjusted mean differences. Secondary endpoints were mean differences in changes in LV end-diastolic volume index (LVEDVI), LV end-systolic volume index (LVESVI), and LV ejection fraction (LVEF). Of the 191 randomized, 165 individuals (median age, 68 years; median BMI, 31.8 kg/m2; 67% were male; and median LVEF, 65%) completed MRI (empagliflozin: 83; placebo: 82). Empagliflozin reduced LVMI with an estimated treatment difference of -1.9 g/m2 (97.5% confidence interval [CI]: -3.5 to -0.2; P = .01). No significant differences were observed for LV volumes or ejection fraction. Among older adults with overweight and cardiovascular disease, empagliflozin 10 mg daily compared with placebo for 180 days led to a significant reduction in LVMI.

Background/Aims: Chronic kidney disease (CKD) is common among patients with heart failure with preserved ejection fraction (HFpEF) and is associated with worse clinical outcomes. This study aims to identify whether the association of CKD with HFpEF is independent of underlying echocardiographic abnormalities. Materials: We conducted a retrospective cohort study including patients without prevalent heart failure referred for echocardiography. Patients with serial echocardiograms, baseline left ventricular ejection fraction (LVEF) ≥50% and estimated glomerular filtration rate (eGFR) ≥90 mL/min/1.73 m2 were matched 1:1 with patients with eGFR <60 mL/min/1.73 m2 for age (±5 years), sex, history of hypertension or diabetes, use of renin-angiotensin inhibitors, and LVEF (±5%). A secondary analysis included patients with preserved LVEF and normal left ventricular mass index matched for the same parameters except use of renin-angiotensin inhibitors. Results: Patients with CKD were at increased risk for HFpEF admission: crude hazard ratio (HR) 1.79 (95% confidence interval [CI] 1.38–2.32, p < 0.001) and adjusted HR (for coronary disease, loop diuretics, left atrial diameter) 1.64 (95% CI 1.22–2.21, p = 0.001). LVEF and left ventricular diameter decreased over time in both groups but no difference was observed in rate of dropping. Results were similar in the secondary analysis (crude HR 1.99, 95% CI 1.07–3.71, p = 0.03 and HR adjusted for left atrial diameter 1.98, 95% CI 1.05–3.75, p = 0.04). Rate of change was similar for LVEF, pulmonary artery pressure, and left ventricular mass index in both groups. Conclusion: CKD is independently associated with incident HFpEF despite a similar change in relevant echocardiographic parameters in patients with or without CKD.

Objective:The present study was conducted to evaluate the correlation of renal functions with thyroid hormone levels in patients with undialyzed chronic kidney disease (CKD). Literature shows significant alteration in thyroid hormone function tests in CKD patients who are receiving long-standing dialysis treatment. However, not much is described in those receiving conservative management without dialysis. Although CKD is associated with an increased prevalence of primary hypothyroidism, various studies on thyroid hormone status in uremic patients have reported conflicting results.Methodology:Thyroid hormone levels and biochemical markers of renal function were estimated in 30 undialyzed CKD patients and similar number of age- and sex-matched healthy controls, followed by statistical analysis and correlation.Results:Free triiodothyronine (FT3) and free thyroxine (FT4) were found to be significantly reduced (P < 0.001 for each) in undialyzed CKD patients whereas thyroid-stimulating hormone (TSH) levels showed statistically insignificant alteration in both groups. We also observed that urea and creatinine were negatively correlated whereas creatinine clearance was positively correlated with both FT3 and FT4 having high statistical (two tailed) significance with P < 0.001. Nonsignificant correlation was seen between blood urea and TSH (r = 0.236, P = 0.069), creatinine clearance, and TSH (r = 0.206, P = 0.114 Pearson's correlation coefficient). There is just significant positive correlation between the serum creatinine values and TSH (r = 0.248, P = 0.049).Conclusions:Thyroid hormones were significantly decreased in undialyzed CKD patients as compared to healthy controls.

Introduction: Chronic kidney disease (CKD) is an independent factor for cardiovascular system complications, such as arterial hypertension, left ventricular hypertrophy (LVH), heart failure or accelerated atherosclerosis progression. The aim of the paper was to analyze left ventricular and arterial remodeling in patients with CKD stages 1–3 to identify the subclinical marker of cardiovascular system damage which changes first in the course of CKD. Methods: The examined group consisted of 90 patients with CKD stage 1–3 and 30 subjects constituting the control group. Left ventricular mass index (LVMI), left ventricular relative wall thickness (RWT) and ejection fraction (EF) were determined by echocardiographic examination. Pulse wave velocity (PWV) between the carotid and femoral arteries as well as common carotid artery intima–media thickness (IMT) was measured. 24-h ambulatory blood pressure monitoring was performed in all subjects. Results: No differences were found between blood pressure values in the examined groups of patients with CKD1, CKD2 and CKD3. Concentric remodeling was found in 20.0%, concentric hypertrophy in 22.2% and eccentric hypertrophy in 18.9% of patients. LVMI values in patients with CKD2 and 3 were higher than in the control group. IMT values in patients with CKD3 were higher than in patients with CKD2. PWV in patients with stage 3 CKD was significantly higher than in the control group (p < 0.05). Conclusions: In the course of CKD, the left ventricle undergoes remodeling earlier than large arterial vessels. Echocardiographic assessment of LVH in early stages of CKD may identify patients at increased cardiovascular risk.

Objective: Diabetic patients with chronic kidney disease (CKD) have an increased risk of cardiovascular disease. We aimed to investigate echocardiogram parameters in relation to estimated glomerular filtration rate (eGFR) and urine albumin/creatinine ratio (ACR). Design and method: We investigated 176 patients both sexes with diabetes type 1 and type 2 aged 55.54 ± 8.37 years. Control group included 50 healthy subjects the same age. Echocardiography was performed to measure left ventricular mass index (LVMI), LV hypertrophy (LVH), systolic function, and diastolic function. LVH was defined as LVMI of 125 g/m2 or more for males and as LVMI of 110 g/m2 or more for females. The renal function of the diabetic patients was evaluated using the albumin-creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR), which was calculated by CKD-EPIscr_cys equation. Results: The prevalence of LVH was higher in diabetic patients with lower values of eGFRscr_cys than in those with normal renal function (56.4% vs 7.1%, respectively, p < 0.05). Diastolic dysfunction of LV was prevalent in 61,4% with the declining renal function vs 7,4% of diabetic patients with normal renal function, p < 0.001. The eGFRscr_cys was negatively associated with total cholesterol, apo-B, uric acid, hs-CRP, pro-BNP and BNP (p < 0.05) and positively associated with left ventricular ejection fraction (LVEF) (p < 0.001). We observed significantly higher LVMI mass index according to reduced eGFRscr_cys (trend p < 0.001) and increased ACR (trend p < 0.001). The multiple regression analysis confirmed the inverse association between eGFRscr_cys and LVMI independently of confounding factors. Conclusions: We confirmed the high prevalence of LVH in patients with diabetes and CKD. Echocardiographic LVH and LV diastolic dysfunction may be predictors of low eGFR in diabetic patients with CKD. Taking into account the pathophysiological processes behind cardiorenal syndrome, cardiac assessment should be evaluated in patients with diabetes and CKD.