The Correlation between Thyroid Hormone Levels and the Kidney Disease Progression Risk in Patients with Type 2 Diabetes

Abstract

Objective

We investigated the relationship between thyroid hormones and the risk of diabetic kidney disease (DKD) progression.

Methods

A total of 452 patients with type 2 diabetes were included, and a cross-sectional analysis was performed. Urine albumin/creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR) were used to diagnose persistent albuminuria and stage chronic kidney disease, respectively. The Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guideline was used to describe the risk of DKD progression (low, moderate, and high or very high risks).

Results

The DKD group had higher levels of thyroid-stimulating hormone (TSH) and lower levels of free triiodothyronine (FT₃) and free thyroxine (FT₄) than the non-DKD group. The prevalence of thyroid dysfunction in the DKD group was significantly higher than in the non-DKD group, especially the prevalence of subclinical hypothyroidism. FT₃ levels decreased gradually with the deterioration of DKD. TSH levels increased with an increasing KDIGO category. FT₃ and FT₄ levels were negatively correlated with serum creatinine levels and ACR, and positively correlated with eGFR. Contrastingly, TSH was positively correlated with ACR, and negatively correlated with eGFR. After adjustment, an increase in FT₃ levels significantly reduced the risk of DKD [odds ratio, OR (95% confidence interval, CI)=0.58 (0.42–0.79)] and DKD progression [ORs (95% CIs)=0.65 (0.45–0.93) for the moderate risk group and 0.50 (0.33–0.74) for the high or very high-risk group, using the low-risk group as a reference]. FT₃ levels below 4.30 pmol/L in men and 3.99 pmol/L in women were the cut-off points for an increased risk of DKD progression.

Conclusion

Low FT₃ level is an independent risk factor for DKD and DKD progression. FT₃ ≤4.30 pmol/L in men and ≤3.99 pmol/L in women will greatly increase the risk of kidney disease progression in patients with type 2 diabetes.

Keywords:

• thyroid hormone
• prognosis of chronic kidney disease
• type 2 diabetes mellitus

Data Sharing Statement

All data included in this study are available upon request by contact with the corresponding author.

Ethics Approval and Consent to Participate

The study protocol was approved by the ethics committee of the Third Hospital of Nanchang. The written informed consent was obtained from each subject. The study was carried out in conformity to the Declaration of Helsinki (as revised in 2013).

Author Contributions

ZY, PD, WL, JL, PT contributed to the conception and design of the study. ZY, WL, RN, XL (X. Lou), LW and KW participated in data collection. ZY and WL were responsible for data analysis and drafting manuscript. PD and XL (X. Lai) critically revised the manuscript. All authors contributed to data analysis, drafting or revising the article, have agreed on the journal to which the article was submitted, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no conflicts of interest for this work.

Additional information

Funding

This work was supported by the National Natural Science Foundation of China [grant number 81760153, Recipient: Peng Duan], the Key Research and Development Programs by Science and Technology Department of Jiangxi Province [grant numbers 20171BBG70058, 20171ACH80002 and 20181BBG70014, Recipient: Zhi Yang, Ping Tu and Jiang Liu], the Science and Technology Support Project by Science and Technology Department of Nanchang City [grant number [2020]133, Recipient: Peng Duan].