PREVALENCE OF HYPOTHYROIDISM IN HEMODIALYSIS AND A SPECIFIC CUT-OFF POINT FOR ITS DIAGNOSIS

Introduction:

Thyroid hormones play a key role in metabolism, development, protein synthesis, the function of all systems, and the regulation of vital hormones. Therefore, their availability is crucial for performing these functions. It has been documented that the kidney is a key modulator in the metabolism, degradation, and elimination of thyroid hormones. Chronic kidney disease can affect the hypothalamic-pituitary-thyroid axis and the metabolism of thyroid hormones. It has been documented that patients undergoing hemodialysis treatment are at higher risk of developing thyroid dysfunctions, with hypothyroidism being the most common. Its diagnosis is challenging since its symptoms overlap with those of patients with chronic kidney disease, which is concerning as it increases cardiovascular risk and morbidity and mortality.  

OBJECTIVE To determine the prevalence of hypothyroidism in patients with chronic kidney disease undergoing hemodialysis. 

Methods:

This is a descriptive, cross-sectional, retrospective study conducted at the Regional Hospital of Puebla from January to September 2023. A total of 85 patients undergoing conventional hemodialysis were included, analyzing their thyroid profile before or at the beginning of the hemodialysis session.

Results:

The average age was 58 years ± 13.1, with 47 men (55.3%). Regarding comorbidities, 83 out of the 85 patients had them: diabetes mellitus was present in 61 patients (71.8%), hypertension in 75 patients (88.2%), and dyslipidemia in 23 patients (27.1%). The prevalence of hypothyroidism was observed in 29 patients (34.1%), with a higher frequency in the male population (13% versus 12%). Among the population with hypothyroidism, 17.6% had subclinical hypothyroidism and 16.5% had clinical hypothyroidism. A cut-off point for the diagnosis of hypothyroidism in this population (patients on hemodialysis) was determined concerning serum levels of Thyroid-Stimulating Hormone (TSH), set at 4.28 UI/ml, with sensitivity/specificity/positive predictive value/negative predictive value of 100%. 

Conclusions:

The prevalence of hypothyroidism in hemodialysis patients was 34.1%, with 17.6% having subclinical hypothyroidism and 16.5% having clinical hypothyroidism. Different TSH cut-off points from the general population should be considered due to the clinical particularities of patients undergoing hemodialysis.

I have no potential conflict of interest to disclose.