Endocrinol Metab.  2022 Apr;37(2):281-289. 10.3803/EnM.2021.1333.

Graves’ Disease and the Risk of End-Stage Renal Disease: A Korean Population-Based Study

Affiliations
  • 1Division of Endocrinology and Metabolism, Department of Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
  • 2Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
  • 3Supportive Care Center/Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
  • 4Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Korea
  • 5Division of Nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
  • 6Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Abstract

Background
Hyperthyroidism is associated with an increased glomerular filtration rate (GFR) in the hyperdynamic state, which is reversible after restoring euthyroidism. However, long-term follow-up of renal dysfunction in patients with hyperthyroidism has not been performed.
Methods
This was a retrospective cohort study using the Korean National Health Insurance database and biannual health checkup data. We included 41,778 Graves’ disease (GD) patients and 41,778 healthy controls, matched by age and sex. The incidences of end-stage renal disease (ESRD) were calculated in GD patients and controls. The cumulative dose and duration of antithyroid drugs (ATDs) were calculated for each patient and categorized into the highest, middle, and lowest tertiles.
Results
Among 41,778 GD patients, 55 ESRD cases occurred during 268,552 person-years of follow-up. Relative to the controls, regardless of smoking, drinking, or comorbidities, including chronic kidney disease, GD patients had a 47% lower risk of developing ESRD (hazard ratio [HR], 0.53; 95% confidence interval [CI], 0.37 to 0.76). In particular, GD patients with a higher baseline GFR (≥90 mL/min/1.73 m2; HR, 0.33; 95% CI, 0.11 to 0.99), longer treatment duration (>33 months; HR, 0.31; 95% CI, 0.17 to 0.58) or higher cumulative dose (>16,463 mg; HR, 0.29; 95% CI, 0.15 to 0.57) of ATDs had a significantly reduced risk of ESRD.
Conclusion
This was the first epidemiological study on the effect of GD on ESRD, and we demonstrated that GD population had a reduced risk for developing ESRD.

Keyword

Graves disease; Kidney failure, chronic; Epidemiology; Antithyroid agents

Figure

  • Fig. 1. Selection of the study population. ESRD, end-stage renal disease.


Cited by  1 articles

Effect of Hyperthyroidism on Preventing Renal Insufficiency
Tae Yong Kim
Endocrinol Metab. 2022;37(2):220-220.    doi: 10.3803/EnM.2022.201.


Reference

1. Kaptein EM, Quion-Verde H, Massry SG. Hemodynamic effects of thyroid hormone. Contrib Nephrol. 1984; 41:151–9.
Article
2. Kaptein EM, Feinstein EI, Massry SG. Thyroid hormone metabolism in renal diseases. Contrib Nephrol. 1982; 33:122–35.
3. Katz AI, Emmanouel DS, Lindheimer MD. Thyroid hormone and the kidney. Nephron. 1975; 15(3-5):223–49.
Article
4. Mariani LH, Berns JS. The renal manifestations of thyroid disease. J Am Soc Nephrol. 2012; 23:22–6.
Article
5. Montenegro J, Gonzalez O, Saracho R, Aguirre R, Gonzalez O, Martinez I. Changes in renal function in primary hypothyroidism. Am J Kidney Dis. 1996; 27:195–8.
Article
6. Cho YY, Kim SK, Jung JH, Hahm JR, Kim TH, Chung JH, et al. Long-term outcomes of renal function after radioactive iodine therapy for thyroid cancer according to preparation method: thyroid hormone withdrawal vs. recombinant human thyrotropin. Endocrine. 2019; 64:293–8.
Article
7. Karanikas G, Schutz M, Szabo M, Becherer A, Wiesner K, Dudczak R, et al. Isotopic renal function studies in severe hypothyroidism and after thyroid hormone replacement therapy. Am J Nephrol. 2004; 24:41–5.
Article
8. den Hollander JG, Wulkan RW, Mantel MJ, Berghout A. Correlation between severity of thyroid dysfunction and renal function. Clin Endocrinol (Oxf). 2005; 62:423–7.
Article
9. Sonmez E, Bulur O, Ertugrul DT, Sahin K, Beyan E, Dal K. Hyperthyroidism influences renal function. Endocrine. 2019; 65:144–8.
Article
10. Kimmel M, Braun N, Alscher MD. Influence of thyroid function on different kidney function tests. Kidney Blood Press Res. 2012; 35:9–17.
Article
11. Kwon H, Jung JH, Han KD, Park YG, Cho JH, Lee DY, et al. Prevalence and annual incidence of thyroid disease in Korea from 2006 to 2015: a nationwide population-based cohort study. Endocrinol Metab (Seoul). 2018; 33:260–7.
Article
12. Hollowell JG, Staehling NW, Flanders WD, Hannon WH, Gunter EW, Spencer CA, et al. Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab. 2002; 87:489–99.
13. Shin DW, Cho B, Guallar E. Korean National Health Insurance Database. JAMA Intern Med. 2016; 176:138.
Article
14. Seo GH, Kim SW, Chung JH. Incidence & prevalence of hyperthyroidism and preference for therapeutic modalities in Korea. J Korean Thyroid Assoc. 2013; 6:56–63.
Article
15. Kim MK, Han K, Koh ES, Kim HS, Kwon HS, Park YM, et al. Variability in total cholesterol is associated with the risk of end-stage renal disease: a nationwide population-based study. Arterioscler Thromb Vasc Biol. 2017; 37:1963–70.
16. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999; 130:461–70.
Article
17. Ross DS, Burch HB, Cooper DS, Greenlee MC, Laurberg P, Maia AL, et al. 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid. 2016; 26:1343–421.
Article
18. Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, et al. 2017 Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid. 2017; 27:315–89.
Article
19. Li X, Misik AJ, Rieder CV, Solaro RJ, Lowen A, Fliegel L. Thyroid hormone receptor alpha 1 regulates expression of the Na+/H+ exchanger (NHE1). J Biol Chem. 2002; 277:28656–62.
20. Santos Ornellas D, Grozovsky R, Goldenberg RC, Carvalho DP, Fong P, Guggino WB, et al. Thyroid hormone modulates ClC-2 chloride channel gene expression in rat renal proximal tubules. J Endocrinol. 2003; 178:503–11.
Article
21. Razvi S, Jabbar A, Pingitore A, Danzi S, Biondi B, Klein I, et al. Thyroid hormones and cardiovascular function and diseases. J Am Coll Cardiol. 2018; 71:1781–96.
Article
22. Vargas F, Moreno JM, Rodriguez-Gomez I, Wangensteen R, Osuna A, Alvarez-Guerra M, et al. Vascular and renal function in experimental thyroid disorders. Eur J Endocrinol. 2006; 154:197–212.
Article
23. Iseki K, Ikemiya Y, Fukiyama K. Risk factors of end-stage renal disease and serum creatinine in a community-based mass screening. Kidney Int. 1997; 51:850–4.
Article
24. Huang B, Zhang Y, Wang L, Wu Q, Li T, Zhang J, et al. Phospholipase A2 receptor autoantibodies as a novel serological biomarker for autoimmune thyroid disease associated nephropathy. Front Immunol. 2020; 11:837.
Article
25. Moon JH, Yi KH. The diagnosis and management of hyperthyroidism in Korea: consensus report of the Korean Thyroid Association. Endocrinol Metab (Seoul). 2013; 28:275–9.
Article
26. Nystrom HF, Jansson S, Berg G. Incidence rate and clinical features of hyperthyroidism in a long-term iodine sufficient area of Sweden (Gothenburg) 2003-2005. Clin Endocrinol (Oxf). 2013; 78:768–76.
Article
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