Thyroid Status, Quality of Life, and Mental Health in Patients on Hemodialysis

Clinical journal of the American Society of Nephrology: CJASN

Connie M. Rhee³ 

[1] and..‡‡Physiology, David Geffen School of Medicine at the University of California, Los Angeles, California..*Division of Nephrology and Hypertension and..†Institute for Clinical and Translational Science, University of California, Irvine, California;**Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California;*Division of Nephrology and Hypertension and..†Institute for Clinical and Translational Science, University of California, Irvine, California;*Division of Nephrology and Hypertension and..‡DaVita Clinical Research, Minneapolis, Minnesota;§Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, Tennessee;¶Los Angeles Biomedical Research Institute, Torrance, California

关键词: Thyroid function;    Thyrotropin;    Mental health;    hemodialysis;    depression;    Depressive Disorder;    Fatigue;    Humans;    Hypothyroidism;    Mental Health;    Outpatients;    Pain;    Prospective Studies;    quality of life;    renal dialysis;    risk factors;    Surveys and Questionnaires;   

DOI  :  10.2215/CJN.13211216

学科分类：泌尿医学

来源: American Society of Nephrology

【 摘 要 】

Background and objectives In the general population, there is increasing recognition of the effect of thyroid function on patient-centered outcomes, including health-related quality of life and depression. Although hypothyroidism is highly prevalent in hemodialysis patients, it is unknown whether thyroid status is a risk factor for impaired health-related quality of life or mental health in this population.Design, setting, participants, & measurements We examined the association of thyroid status, defined by serum thyrotropin, with health-related quality of life and depressive symptoms over time in a prospective cohort of 450 patients on hemodialysis from 17 outpatient dialysis facilities from May of 2013 to May of 2015 who underwent protocolized thyrotropin testing, Short-Form 36 surveys, and Beck Depression Inventory-II questionnaires every 6 months. We examined the association of baseline and time-dependent thyrotropin categorized as tertiles and continuous variables with eight Short-Form 36 domains and Beck Depression Inventory-II scores using expanded case mix plus laboratory adjusted linear mixed effects models.Results In categorical analyses, the highest baseline thyrotropin tertile was associated with a five-point lower Short-Form 36 domain score for energy/fatigue (P=0.04); the highest time-dependent tertile was associated with a five-point lower physical function score (P=0.03; reference: lowest tertile). In continuous analyses, higher baseline serum thyrotropin levels (+Δ1 mIU/L) were associated with lower role limitations due to physical health (β=−1.3; P=0.04), energy/fatigue (β=−0.8; P=0.03), and pain scores (β=−1.4; P=0.002), equivalent to five-, three-, and five-point lower scores, respectively, for every 1-SD higher thyrotropin. Higher time-dependent thyrotropin levels were associated with lower role limitations due to physical health scores (β=−1.0; P=0.03), equivalent to a three-point decline for every 1-SD higher thyrotropin. Baseline and time-dependent thyrotropin were not associated with Beck Depression Inventory-II scores.Conclusions In patients on hemodialysis, higher serum thyrotropin levels are associated with impaired health-related quality of life across energy/fatigue, physical function, and pain domains. Studies are needed to determine if thyroid-modulating therapy improves the health-related quality of life of hemodialysis patients with thyroid dysfunction.Podcast This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2017_07_13_Rhee_Brent.mp3

【 授权许可】

CC BY