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Thyroid dysfunction develops as chronic kidney disease progresses to advanced stages until reaching renal replacement therapy, resulting in specific thyroid disorders in the hemodialysis modality; however, there are limited studies regarding the frequency of the variety of presentation and association of thyroid dysfunction in adult patients with chronic kidney disease on hemodialysis from Mediterranean geographical areas with a deficiency of iodized soils and high altitude inhabitants, in the context of the city of La Paz – Bolivia, located at (3650 m.s.n.m), which It would help to understand the context of the prevalence and association of the thyroid-renal axis disorder in high-altitude inhabitants undergoing hemodialysis.
An observational, retrospective, cross-sectional correlational study was developed. There is a sample of 40 patients from the Hemodialysis unit of the Nephrology service of the Hospital de Clínicas Universitario, in the period from October to December 2022. Levels of thyrotropin hormone, free and total thyroxine, free and total triiodothyronine, and phosphorus were requested, calcium, parathyroid hormone, albumin, hemoglobin. The SPSS version 20 program was used; chi square and cramer's V were used to determine the association, considering p > 0.05 a statistically significant value.
The prevalence of thyroid dysfunction in the hemodialysis unit of the Hospital de Clínicas Universitario was (60%) of the total number of patients studied, where the euthyroid disease syndrome constitutes the most frequent syndrome (37.5%), followed by subclinical hypothyroidism with ( 22.5%), the association between thyroid dysfunction in adults with chronic kidney disease and hemodialysis time was (p=0.027; V cramer: 0.349), which indicates an intermediate association between these two variables, of which ( 91.7%) present anemia with a statistically significant association (p=0.04; V cramer: 0.04; OR: 5, 95% CI: 8.833 - 30.021). Regarding albumin, a significant association is evident (p= 0.036; Cramer V: 0.824; OR: 1.5, 95% CI: 2.271 - 3.694), which leads to a greater probability of presenting thyroid dysfunction.
In the context of the study population, the prevalence of sick euthyroid syndrome is evident, with a higher frequency of presentation, presenting a significant association after exposure to hemodialysis, which contributes to greater morbidity and mortality. These findings suggest that the assessment of thyroid function should be introduced as part of screening in the management guidelines for chronic kidney disease and/or applied in patients with risk factors, even more so in patients undergoing hemodialysis, which would contribute to assess the quality of life and adequacy of dialysis, after monitoring and correlating with other variables, reducing the progression and mortality of patients with chronic kidney disease until they are admitted to hemodialysis.