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Association of triiodothyronine levels with left ventricular function, cardiovascular events, and mortality in hemodialysis patients

Association of triiodothyronine levels with left ventricular function, cardiovascular events, and mortality in hemodialysis patients

Int J Artif Organs 2017; 40(2): 60 - 66

Article Type: ORIGINAL RESEARCH ARTICLE

DOI:10.5301/ijao.5000569

Authors

Jianjun Gao, Yongxing Xu, Deyang Kong, Lei Zhou, Huaping Jia, Boran Liang, Zhaoyan Gu

Abstract

Background

Hemodialysis (HD) patients have altered free triiodothyronine (fT3) levels. A low fT3 level is a strong and inverse mortality predictor in HD patients. However, little is known about the relationship between fT3 and left ventricular function in HD patients.

Methods

A total of 128 maintenance HD patients were enrolled in this study. A thyroid function test with blood sampling and echocardiography was conducted. Low-T3 syndrome was defined as fT3 level <3.62 pmol/L and normal thyroid stimulating hormone (TSH). Overall mortality and rate of cardiovascular (CV) events were assessed during 48 months of follow-up.

Results

Low-T3 syndrome was detected in 57 (44.5%) of the 128 patients. Patients with low-T3 syndrome had a shorter duration of HD (49.1 vs. 73.3, p = 0.01), and lower serum albumin (35.1 vs. 40.4 g/L, p<0.001), left ventricular ejection fraction (LVEF; 54.7% vs. 63.9%, p<0.001), and fractional shortening at endocardial levels (endoFS; 29.3% vs. 34.8%, p = 0.001) compared to those with normal fT3 levels. In multivariate linear regression, LVEF, albumin, and duration of HD were independently correlated with fT3 levels. In addition, fT3 was also correlated with LVEF. During the study period, 13 (10.1%) patients died, CV events occurred in 15 (11.7%) patients. In Cox regression analysis, low fT3 level and elevated high-sensitivity C-reactive protein (hs-CRP) were associated with mortality and CV events.

Conclusions

In HD patients, fT3 level is positively correlated with LVEF. Low fT3 level and elevated hs-CRP predicted all-cause mortality and CV events.

Article History

Disclosures

Financial support: The study was supported by a National Natural Science Foundation of China grant to Z.Y.G. (No. 81300265), and by a grant from the Hainan Natural Science Foundation of China to Z.Y.G. (No. 20168350).
Conflict of interest: None of the authors has financial interest related to this study to disclose.

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Authors

Affiliations

  • Department of Nephrology, the 306th Hospital of Chinese People’s Liberation Army, Beijing - China
  • Department of Nephrology, 1st Affiliated Hospital of Harbin Medical University, Harbin - China
  • Department of Ultrasonography, the 306th Hospital of the Chinese People’s Liberation Army, Beijing - China
  • Healthcare Department, Hainan Branch of the Chinese People’s Liberation Army General Hospital, SanYa - China
  • Jianjun Gao, Yongxing Xu and Deyang Kong contributed equally to this work.

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