Palabras clave
glándula tiroides
riñón
fallo renal crónico
tasa de filtración glomerular
diálisis
hipotiroidismo
tirotropina.
riñón
fallo renal crónico
tasa de filtración glomerular
diálisis
hipotiroidismo
tirotropina.
Cómo citar
1.
Chavez WF, Ariza García AM, Ramos Clason EC. Caracterización de la disfunción tiroidea en adultos con enfermedad renal crónica en diálisis. Rev. Colomb. Nefrol. [Internet]. 9 de agosto de 2018 [citado 3 de julio de 2024];5(2):156-65. Disponible en: https://revistanefrologia.org/index.php/rcn/article/view/312
Resumen
Introducción: existe una clara relación entre la disfunción tiroidea y la enfermedad renal crónica (ERC) que se evidencia por el aumento de la prevalencia de hipotiroidismo primario a medida que disminuye la tasa de filtración glomerular.
Objetivo: caracterizar los pacientes adultos con disfunción tiroidea y enfermedad renal crónica en terapia dialítica.
Métodos: se realizó un estudio observacional de tipo descriptivo, transversal, que caracterizó y recolectó datos de laboratorio en pacientes mayores de 18 años con ERC. Estos pacientes se encontraban en terapia dialítica en una unidad renal de la ciudad de Cartagena (Colombia) y se les practicó un control de TSH en el año 2016.
Resultados: se incluyeron 350 pacientes con registro de TSH. La mediana de edad fue de 59 años y el 49.1% eran mujeres. La principal causa de la ERC fue la hipertensión (36.3%) y la principal comorbilidad fue el hiperpatioidismo (56%). En relación con la disfunción tiroidea, se evidenció que el 25.4% de la población presentó niveles de TSH mayores a 4.5 ?IU/mL. Dentro de este segmento, un 5.7% se encontraba en rango de hipotiroidismo (TSH>10 ?IU/mL).
Conclusiones: la prevalencia de la disfunción tiroidea fue mayor en la muestra, en comparación con la población general. No obstante, se requieren estudios adicionales con medición de T4L para realizar una adecuada categorización.
Citas
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doi:10.11144/Javeriana.rgyps15-30.ercc.
2. Basu G, Mohapatra A. Interactions between thyroid disorders and kidney disease. Indian J Endocrinol Metab. 2012;16(2):204-213. https://doi.org/10.4103/2230-8210.93737
3. Khatiwada S, Kc R, Gautam S, Lamsal M, Baral N. Thyroid dysfunction and dyslipidemia in chronic kidney disease patients. BMC Endocr Disord. 2015;15:65. https://doi.org/10.1186/s12902-015-0063-9
4. Mohamedali M, Reddy Maddika S, Vyas A, Iyer V, Cheriyath P. Thyroid disorders and chronic kidney disease. Int J Nephrol. 2014;2014:520281. https://doi.org/10.1155/2014/520281
5. Kulkarni DP, Holley JL. Thyroid function test in end-stage renal disease. Semin Dial. 2014;27:552-555. https://doi.org/10.1111/sdi.12266
6. Rhee CM. The interaction between thyroid and kidney disease: an overview of the evidence. Curr Opin Endocrinol Diabetes Obes. 2016;23(5):407-415. https://doi.org/10.1097/MED.0000000000000275
7. Rhee CM, Kalantar-Zadeh K, Streja E, Carrero J-J, Ma JZ, Lu JL, et al. The relationship between thyroid function and estimated glomerular filtration rate in patients with chronic kidney disease. Nephrol Dial Transplant. 2014;30(2):282-287. https://doi.org/10.1093/ndt/gfu303
8. Rhee CM, Alexander EK, Bhan I, Brunelli SM. Hypothyroidism and mortality among dialysis patients. Clin J Am Soc Nephrol. 2013;8:593-6019. https://doi.org/10.2215/CJN.06920712
9. Rhee CM, Ravel VA, Streja E, Mehrotra R, Kim S, Wang J, et al. Thyroid functional disease and mortality in a national peritoneal dialysis cohort. J Clin Endocrinol Metab. 2016;101(11):4054-4061.
https://doi.org10.1210/jc.2016-1691
10. Rhee CM, Kim S, Gillen DL, Oztan T, Wang J, Mehrotra R, et al. Association of thyroid functional disease with mortality in a national cohort of incident hemodialysis patients. J Clin Endocrinol Metab. 2015;100(4):1386-1395. https://doi.org/10.1210/jc.2014-4311
11. Tatar E, Kircelli F, Ok E. The contribution of thyroid dysfunction on cardiovascular disease in patients with chronic kidney disease. Atherosclerosis. 2013;227(1):26-31.
https://doi.org/10.1016/j.atherosclerosis.2012.10.068
12. Jha V, Garcia-Garcia G, Iseki K, Li Z, Naicker S, Plattner B, et al. Chronic kidney disease: global dimension and perspectives. Lancet. 2013;382(9888):260-272.
https://doi.org/10.1016S0140-6736(13)60687-X
13. Martínez FL, Ordóñez IE, García DL. Deficiencias en el tratamiento de pacientes diabéticos que terminaron en enfermedad renal crónica. Acta Med Colomb. 2007;32(2):57-67.
14. Abraham G, Arun K, Gopalakrishnan N, Renuka S, Pahari DK, Deshpande P, et al. Management of Hypertension in Chronic Kidney Disease: Consensus Statement by an Expert Panel of Indian Nephrologists. J Assoc Physicians India. 2017;65(2):6-22.
15. Ministerio de Salud y Protección Social. Situación de la enfermedad renal crónica, hipertensión arterial y diabetes mellitus, 2015 [Internet]. Bogotá: Ministerio de Salud y Protección Social; 2015. Disponible en: https://cuentadealtocosto.org/site/images/Situaci%C3%B3n_de_la_Enfermedad_Renal_Cr%C3%B3nica_en_Colombia_2015.pdf.
16. Mendelssohn DC, Ethier J, Elder SJ, Saran R, Port FK, Pisoni RL. Haemodialysis vascular access problems in Canada: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS II). Nephrol Dial Transplant. 2005;21(3):721-728. https://doi.org/10.1093/ndt/gfi281
17. Douthat WG, Castellano M, Berenguer L, Guzmán MA, Arteaga Jd, Chiurchiu CR, et al. Elevada prevalencia de hiperparatiroidismo secundario en pacientes con enfermedad renal crónica en diálisis en Argentina. Nefrología (Madr.). 2013;33(5):657-666. https://doi.org/10.3265/Nefrologia.pre2013.May.12009
18. Nakhoul G, Simon JF. Anemia of chronic kidney disease: Treat it, but not too aggressively. Cleve Clin J Med. 2016;83(8):613-624. https://doi.org/10.3949/ccjm.83a.15065
19. Pineda J, Galofré JC, Toni M, Anda E. Hipotiroidismo. Medicine. 2016; 12:722-730. https://doi.org/10.1016/j.med.2016.06.002
20. Chandra A. Prevalence of hypothyroidism in patients with chronic kidney disease: a cross-sectional study from North India. Kid ney Res Clin Pract. 2016;35(3):165-168. https://doi.org/10.1016/j.krcp.2016.06.003
21. Bajaj S, Purwar N, Gupta A, Gupta P, Srivastava A. Prevalence of hypothyroidism in nondiabetic chronic kidney disease and effect of thyroxine replacement on estimated glomerular filtration rate. Indian J Nephrol. 2017;27(2):104-107.
https://doi.org/10.41030971-4065.181464
22. Sanai T, Okamura K, Rikitake S, Fukuda M, Onozawa K, Sanematsu M, et al. The high prevalence of reversible subclinical hypothyroidism with elevated serum thyroglobulin levels in chronic kidney disease patients. Clin Nephrol. 2017;87(5):237-244. https://doi.org/10.5414/CN109008
23. Lo JC, Chertow GM, Go AS, Hsu C-Y. Increased prevalence of subclinical and clinical hypothyroidism in persons with chronic kidney disease. Kidney Int. 2005;67(3):1047-1052.
https://doi.org/10.1111/j.1523-1755.2005.00169.x
24. Ng YY, Wu SC, Da Lin H, Hu FH, Hou CC, Chou YY, et al. Prevalence of clinical and subclinical thyroid disease in a peritoneal dialysis population. Perit Dial Int. 2012;32(1):86-93. https://doi.org/10.3747/pdi.2010.00202
25. Garber JR, Cobin RH, Gharib H, Hennessey JV, Klein I, Mechanick JI, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocr Pract. 2012;22(12):1200-35. https://doi.org/10.4158/EP12280.GL
26. Bensenor IM, Olmos RD, Lotufo PA. Hypothyroidism in the elderly: diagnosis and management. Clin Interv Aging. 2012;7:97-111. https://doi.org/10.2147/CIA.S23966
27. Ashmaik A, Gabra HM, Elzein AOM, Shrif NEMA, Hassan EE. Assessment of serum levels of calcium and phosphorous in Sudanese patients with hypothyroidism. Asian J Biomed Pharm Sci. 2013;3(25):21-26.
28. Shivaleela MB, Poornima RT, Jayaprakash Murthy DS. Serum calcium and phosphorus levels in thyroid dysfunction. Indian journal of fundamental and applied life sciences. 2012;2(2):179-183.
29. Suneel B, Nagendra DR, Aparna RR, Balakrishna D, Naidu JN. Mineral Status in Thyroid Disorder (Hypo & Hyper). Int J Appl Biol Pharm. 2011;2(4):423-429.
30. Bellorin-Font E, Ambrosoni P, Carlini RG, Carvalho AB, Correa-Rotter R, Cueto-Manzano A, et al. Clinical practice guidelines for the prevention, diagnosis, evaluation and treatment of mineral and bone disorders in chronic kidney disease (CKD-MBD) in adults. Nefrologia. 2013;33(1):1-28. https://doi.org/10.3265/Nefrologia.pre2013.Feb.11945
31. Carrero J, Qureshi A, Axelsson J, Yilmaz M, Rehnmark S, Witt M, et al. Clinical and biochemical implications of low thyroid hormone levels (total nd free forms) in euthyroid patients with chronic kidney disease. J Intern Med. 2007;262(6):690-701.
https://doi.org/10.1111j.1365-2796.2007.01865.x
32. Zoccali C, Mallamaci F, Tripepi G, Cutrupi S, Pizzini P. Low triiodothyronine and survival in end-stage renal disease. Kidney international. 2006;70(3):523-8. https://doi.org/10.1038/sj.ki.5001566
33. Lin HJ, Lin CC, Lin HM, Chen HJ, Lin CC, Chang CT, et al. Hypothyroidism is associated with all?cause mortality in a national cohort of chronic hemodialysis patients. Nephrology (Carlton). 2017;23(6): 559-564. https://doi.org/10.1111/nep.13049
34. Shin DH, Lee MJ, Lee HS, Oh HJ, Ko KI, Kim CH, et al. Thyroid hormone replacement therapy attenuates the decline of renal function in chronic kidney disease patients with subclinical hypothyroidism. Thyroid. 2013;23(6):654-61. https://doi.org/10.1089/thy.2012.0475
35. Rhee CM. The interaction between thyroid and kidney disease: an overview of the evidence. Curr Opin Endocrinol Diabetes Obes. 2016;23(5):407-15. https://doi.org/10.1097/MED.0000000000000275
doi:10.11144/Javeriana.rgyps15-30.ercc.
2. Basu G, Mohapatra A. Interactions between thyroid disorders and kidney disease. Indian J Endocrinol Metab. 2012;16(2):204-213. https://doi.org/10.4103/2230-8210.93737
3. Khatiwada S, Kc R, Gautam S, Lamsal M, Baral N. Thyroid dysfunction and dyslipidemia in chronic kidney disease patients. BMC Endocr Disord. 2015;15:65. https://doi.org/10.1186/s12902-015-0063-9
4. Mohamedali M, Reddy Maddika S, Vyas A, Iyer V, Cheriyath P. Thyroid disorders and chronic kidney disease. Int J Nephrol. 2014;2014:520281. https://doi.org/10.1155/2014/520281
5. Kulkarni DP, Holley JL. Thyroid function test in end-stage renal disease. Semin Dial. 2014;27:552-555. https://doi.org/10.1111/sdi.12266
6. Rhee CM. The interaction between thyroid and kidney disease: an overview of the evidence. Curr Opin Endocrinol Diabetes Obes. 2016;23(5):407-415. https://doi.org/10.1097/MED.0000000000000275
7. Rhee CM, Kalantar-Zadeh K, Streja E, Carrero J-J, Ma JZ, Lu JL, et al. The relationship between thyroid function and estimated glomerular filtration rate in patients with chronic kidney disease. Nephrol Dial Transplant. 2014;30(2):282-287. https://doi.org/10.1093/ndt/gfu303
8. Rhee CM, Alexander EK, Bhan I, Brunelli SM. Hypothyroidism and mortality among dialysis patients. Clin J Am Soc Nephrol. 2013;8:593-6019. https://doi.org/10.2215/CJN.06920712
9. Rhee CM, Ravel VA, Streja E, Mehrotra R, Kim S, Wang J, et al. Thyroid functional disease and mortality in a national peritoneal dialysis cohort. J Clin Endocrinol Metab. 2016;101(11):4054-4061.
https://doi.org10.1210/jc.2016-1691
10. Rhee CM, Kim S, Gillen DL, Oztan T, Wang J, Mehrotra R, et al. Association of thyroid functional disease with mortality in a national cohort of incident hemodialysis patients. J Clin Endocrinol Metab. 2015;100(4):1386-1395. https://doi.org/10.1210/jc.2014-4311
11. Tatar E, Kircelli F, Ok E. The contribution of thyroid dysfunction on cardiovascular disease in patients with chronic kidney disease. Atherosclerosis. 2013;227(1):26-31.
https://doi.org/10.1016/j.atherosclerosis.2012.10.068
12. Jha V, Garcia-Garcia G, Iseki K, Li Z, Naicker S, Plattner B, et al. Chronic kidney disease: global dimension and perspectives. Lancet. 2013;382(9888):260-272.
https://doi.org/10.1016S0140-6736(13)60687-X
13. Martínez FL, Ordóñez IE, García DL. Deficiencias en el tratamiento de pacientes diabéticos que terminaron en enfermedad renal crónica. Acta Med Colomb. 2007;32(2):57-67.
14. Abraham G, Arun K, Gopalakrishnan N, Renuka S, Pahari DK, Deshpande P, et al. Management of Hypertension in Chronic Kidney Disease: Consensus Statement by an Expert Panel of Indian Nephrologists. J Assoc Physicians India. 2017;65(2):6-22.
15. Ministerio de Salud y Protección Social. Situación de la enfermedad renal crónica, hipertensión arterial y diabetes mellitus, 2015 [Internet]. Bogotá: Ministerio de Salud y Protección Social; 2015. Disponible en: https://cuentadealtocosto.org/site/images/Situaci%C3%B3n_de_la_Enfermedad_Renal_Cr%C3%B3nica_en_Colombia_2015.pdf.
16. Mendelssohn DC, Ethier J, Elder SJ, Saran R, Port FK, Pisoni RL. Haemodialysis vascular access problems in Canada: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS II). Nephrol Dial Transplant. 2005;21(3):721-728. https://doi.org/10.1093/ndt/gfi281
17. Douthat WG, Castellano M, Berenguer L, Guzmán MA, Arteaga Jd, Chiurchiu CR, et al. Elevada prevalencia de hiperparatiroidismo secundario en pacientes con enfermedad renal crónica en diálisis en Argentina. Nefrología (Madr.). 2013;33(5):657-666. https://doi.org/10.3265/Nefrologia.pre2013.May.12009
18. Nakhoul G, Simon JF. Anemia of chronic kidney disease: Treat it, but not too aggressively. Cleve Clin J Med. 2016;83(8):613-624. https://doi.org/10.3949/ccjm.83a.15065
19. Pineda J, Galofré JC, Toni M, Anda E. Hipotiroidismo. Medicine. 2016; 12:722-730. https://doi.org/10.1016/j.med.2016.06.002
20. Chandra A. Prevalence of hypothyroidism in patients with chronic kidney disease: a cross-sectional study from North India. Kid ney Res Clin Pract. 2016;35(3):165-168. https://doi.org/10.1016/j.krcp.2016.06.003
21. Bajaj S, Purwar N, Gupta A, Gupta P, Srivastava A. Prevalence of hypothyroidism in nondiabetic chronic kidney disease and effect of thyroxine replacement on estimated glomerular filtration rate. Indian J Nephrol. 2017;27(2):104-107.
https://doi.org/10.41030971-4065.181464
22. Sanai T, Okamura K, Rikitake S, Fukuda M, Onozawa K, Sanematsu M, et al. The high prevalence of reversible subclinical hypothyroidism with elevated serum thyroglobulin levels in chronic kidney disease patients. Clin Nephrol. 2017;87(5):237-244. https://doi.org/10.5414/CN109008
23. Lo JC, Chertow GM, Go AS, Hsu C-Y. Increased prevalence of subclinical and clinical hypothyroidism in persons with chronic kidney disease. Kidney Int. 2005;67(3):1047-1052.
https://doi.org/10.1111/j.1523-1755.2005.00169.x
24. Ng YY, Wu SC, Da Lin H, Hu FH, Hou CC, Chou YY, et al. Prevalence of clinical and subclinical thyroid disease in a peritoneal dialysis population. Perit Dial Int. 2012;32(1):86-93. https://doi.org/10.3747/pdi.2010.00202
25. Garber JR, Cobin RH, Gharib H, Hennessey JV, Klein I, Mechanick JI, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocr Pract. 2012;22(12):1200-35. https://doi.org/10.4158/EP12280.GL
26. Bensenor IM, Olmos RD, Lotufo PA. Hypothyroidism in the elderly: diagnosis and management. Clin Interv Aging. 2012;7:97-111. https://doi.org/10.2147/CIA.S23966
27. Ashmaik A, Gabra HM, Elzein AOM, Shrif NEMA, Hassan EE. Assessment of serum levels of calcium and phosphorous in Sudanese patients with hypothyroidism. Asian J Biomed Pharm Sci. 2013;3(25):21-26.
28. Shivaleela MB, Poornima RT, Jayaprakash Murthy DS. Serum calcium and phosphorus levels in thyroid dysfunction. Indian journal of fundamental and applied life sciences. 2012;2(2):179-183.
29. Suneel B, Nagendra DR, Aparna RR, Balakrishna D, Naidu JN. Mineral Status in Thyroid Disorder (Hypo & Hyper). Int J Appl Biol Pharm. 2011;2(4):423-429.
30. Bellorin-Font E, Ambrosoni P, Carlini RG, Carvalho AB, Correa-Rotter R, Cueto-Manzano A, et al. Clinical practice guidelines for the prevention, diagnosis, evaluation and treatment of mineral and bone disorders in chronic kidney disease (CKD-MBD) in adults. Nefrologia. 2013;33(1):1-28. https://doi.org/10.3265/Nefrologia.pre2013.Feb.11945
31. Carrero J, Qureshi A, Axelsson J, Yilmaz M, Rehnmark S, Witt M, et al. Clinical and biochemical implications of low thyroid hormone levels (total nd free forms) in euthyroid patients with chronic kidney disease. J Intern Med. 2007;262(6):690-701.
https://doi.org/10.1111j.1365-2796.2007.01865.x
32. Zoccali C, Mallamaci F, Tripepi G, Cutrupi S, Pizzini P. Low triiodothyronine and survival in end-stage renal disease. Kidney international. 2006;70(3):523-8. https://doi.org/10.1038/sj.ki.5001566
33. Lin HJ, Lin CC, Lin HM, Chen HJ, Lin CC, Chang CT, et al. Hypothyroidism is associated with all?cause mortality in a national cohort of chronic hemodialysis patients. Nephrology (Carlton). 2017;23(6): 559-564. https://doi.org/10.1111/nep.13049
34. Shin DH, Lee MJ, Lee HS, Oh HJ, Ko KI, Kim CH, et al. Thyroid hormone replacement therapy attenuates the decline of renal function in chronic kidney disease patients with subclinical hypothyroidism. Thyroid. 2013;23(6):654-61. https://doi.org/10.1089/thy.2012.0475
35. Rhee CM. The interaction between thyroid and kidney disease: an overview of the evidence. Curr Opin Endocrinol Diabetes Obes. 2016;23(5):407-15. https://doi.org/10.1097/MED.0000000000000275
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