Diabetes, Metabolic Syndrome and Obesity (Jan 2022)
The Correlation between Thyroid Hormone Levels and the Kidney Disease Progression Risk in Patients with Type 2 Diabetes
Abstract
Zhi Yang,1– 3 Peng Duan,2 Weihong Li,2 Ronghui Nie,2,3 Xiaoyang Lou,2,4 Lina Wang,2 Kexia Wu,2 Jiang Liu,2 Ping Tu,2 Xiaoyang Lai1 1Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Nanchang University, Nanchang, 330008, Jiangxi, People’s Republic of China; 2Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang, 330000, Jiangxi, People’s Republic of China; 3Jiangxi Medical College of Nanchang University, Nanchang, 330036, Jiangxi, People’s Republic of China; 4Jiangxi University of Traditional Chinese Medicine, Nanchang, 330004, Jiangxi, People’s Republic of ChinaCorrespondence: Xiaoyang Lai Tel +86 13607916298Email [email protected]: We investigated the relationship between thyroid hormones and the risk of diabetic kidney disease (DKD) progression.Methods: A total of 452 patients with type 2 diabetes were included, and a cross-sectional analysis was performed. Urine albumin/creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR) were used to diagnose persistent albuminuria and stage chronic kidney disease, respectively. The Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guideline was used to describe the risk of DKD progression (low, moderate, and high or very high risks).Results: The DKD group had higher levels of thyroid-stimulating hormone (TSH) and lower levels of free triiodothyronine (FT3) and free thyroxine (FT4) than the non-DKD group. The prevalence of thyroid dysfunction in the DKD group was significantly higher than in the non-DKD group, especially the prevalence of subclinical hypothyroidism. FT3 levels decreased gradually with the deterioration of DKD. TSH levels increased with an increasing KDIGO category. FT3 and FT4 levels were negatively correlated with serum creatinine levels and ACR, and positively correlated with eGFR. Contrastingly, TSH was positively correlated with ACR, and negatively correlated with eGFR. After adjustment, an increase in FT3 levels significantly reduced the risk of DKD [odds ratio, OR (95% confidence interval, CI)=0.58 (0.42– 0.79)] and DKD progression [ORs (95% CIs)=0.65 (0.45– 0.93) for the moderate risk group and 0.50 (0.33– 0.74) for the high or very high-risk group, using the low-risk group as a reference]. FT3 levels below 4.30 pmol/L in men and 3.99 pmol/L in women were the cut-off points for an increased risk of DKD progression.Conclusion: Low FT3 level is an independent risk factor for DKD and DKD progression. FT3 ≤ 4.30 pmol/L in men and ≤ 3.99 pmol/L in women will greatly increase the risk of kidney disease progression in patients with type 2 diabetes.Keywords: thyroid hormone, prognosis of chronic kidney disease, type 2 diabetes mellitus
