The association between thyroid function and nutritional status in patients with end-stage renal disease on hemodialysis

Pub Date : 2020-01-01 DOI:10.1080/20905068.2020.1863040

W. Shehab-Eldin, M. Shaaban, Mai Abdel Samed Atia, S. Zewain

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Abstract

ABSTRACT Introduction: Malnutrition is common in patients with End-Stage Renal Disease (ESRD) on hemodialysis (HD) which significantly affects their quality of life. ESRD is associated with thyroid dysfunction which may affect morbidity and mortality. Changes in thyroid function in this population could be a marker of malnutrition. Our aim was the assessment of the nutritional status of patients with ESRD on HD and its association with thyroid function. Methods: A cross-sectional study was conducted on 84 patients with ESRD on HD. Nutritional status was assessed by anthropometric measurements and Subjective Global Assessment (SGA) Score. Serum FT3, FT4, and TSH concentrations were determined. CBC, kidney function tests, serum albumin, serum iron, total iron-binding capacity, serum cholesterol, and CRP were measured. Patients’ comorbidity status was determined using the Charlson Comorbidity Index (CCI). Results: The mean SGA score for studied patients was 13.73 ± 4.4, mean values of thyroid functions were: TSH 2.99 ± 2.93uIU/ml; FT4 1.08 ± 0.21 ng/dl and FT3 2.55 ± 0.52 pg/ml. According to SGA score, 26.2% of patients had normal nutritional status, 69% had mild to moderate malnutrition and 4.8% had severe malnutrition. SGA had significant negative correlation with FT3, while there was no significant correlation between it and FT4 or TSH. Serum FT3 concentration inversely correlated with age (r = −0.25, P= 0.02), CCI (r = −0.48, P= 0.0001), CRP (r = −0.46, P= 0.0001), and SGA (r = −0.49, P= 0.0001), and positively correlated with serum albumin (r = 0.47, P= 0.0001). In multivariate regression analysis, SGA was independently associated with FT3 (β, −1.36; 95% confidence interval, −2.5 to −0.2, P= 0.02) Conclusions: Malnutrition is prevalent among patients with ESRD on HD. FT3 is a marker of malnutrition and could be used as an accessible and reproducible periodical method to detect such states.

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终末期肾病血液透析患者甲状腺功能与营养状况的关系

摘要简介：营养不良在血液透析（HD）的终末期肾病（ESRD）患者中很常见，严重影响他们的生活质量。ESRD与甲状腺功能障碍有关，甲状腺功能障碍可能影响发病率和死亡率。这一人群甲状腺功能的变化可能是营养不良的标志。我们的目的是评估HD ESRD患者的营养状况及其与甲状腺功能的关系。方法：对84例HD ESRD患者进行横断面研究。营养状况通过人体测量和主观整体评估（SGA）评分进行评估。测定血清FT3、FT4和TSH浓度。测定CBC、肾功能检查、血清白蛋白、血清铁、总铁结合能力、血清胆固醇和CRP。采用Charlson共病指数（CCI）确定患者的共病状态。结果：研究患者的平均SGA评分为13.73±4.4，甲状腺功能平均值为：TSH 2.99±2.93uIU/ml；FT4 1.08±0.21 ng/ml和FT3 2.55±0.52 pg/ml。根据SGA评分，26.2%的患者营养状况正常，69%的患者轻度至中度营养不良，4.8%的患者重度营养不良。SGA与FT3呈显著负相关，而与FT4或TSH无显著相关性。血清FT3浓度与年龄（r=-0.25，P=0.02）、CCI（r=-0.48，P=0.001）、CRP（r=-0.46，P=0.001，SGA与FT3独立相关（β，−1.36；95%置信区间，−2.5至−0.2，P=0.02）结论：营养不良在HD ESRD患者中普遍存在。FT3是营养不良的标志物，可以作为一种可获得和可重复的周期性方法来检测这种状态。

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