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Nonthyroidal illness: a risk factor for coronary calcification and arterial stiffness in patients undergoing peritoneal dialysis?
Author(s) -
Meuwese Christiaan L.,
Carrero Juan J.,
CabezasRodríguez Iván,
Heimburger Olof,
Barany Peter,
Lindholm Bengt,
Qureshi Abdul R.,
Ripsweden Jonaz,
Dekker Friedo W.,
Stenvinkel Peter
Publication year - 2013
Publication title -
journal of internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.625
H-Index - 160
eISSN - 1365-2796
pISSN - 0954-6820
DOI - 10.1111/joim.12107
Subject(s) - medicine , arterial stiffness , cardiology , peritoneal dialysis , interquartile range , pulse pressure , blood pressure , dialysis , pulse wave velocity , coronary artery disease , confidence interval , surgery
Abstract Objectives Low triiodothyronine levels, as part of the nonthyroidal illness syndrome, are common in dialysis patients and have repeatedly been shown to be associated with increased (cardiovascular) mortality rates. We hypothesized that increased vascular calcification may mediate this relationship. Methods A total of 84 patients from the Stockholm region receiving maintenance peritoneal dialysis were included in the study. Serum concentrations of free triiodothyronine ( fT 3), thyroxine and thyroid‐stimulating hormone were measured. Coronary artery calcium (CAC) scores were assessed by cardiac computed tomography scans. Surrogates of arterial stiffness included aortic diastolic and systolic blood pressures, pulse pressure, augmentation pressure and Buckberg's subendocardial viability ratio measured by pulse waveform analyses. Patients were subsequently followed, and events of death and censoring were recorded. Thyroid hormone concentrations were associated with CAC scores, measures of arterial stiffness and all‐cause mortality. The associations between CAC scores and arterial stiffness surrogates and mortality were also determined to evaluate a possible causal pathway. Results Both CAC scores and arterial stiffness surrogates were substantially higher in individuals with low fT 3 levels. These associations persisted in multivariate logistic and linear regression analyses. During a median (interquartile range) follow‐up of 32 (22–42) months, 24 patients died. Both fT 3 levels below the median value [HR crude 4.1, 95% confidence interval (CI) 1.4–12.6] and CAC scores above the median value (HR crude 5.8, 95% CI 1.7–20.1) were strongly associated with mortality. Conclusions In patients undergoing peritoneal dialysis, fT 3 levels were strongly associated with arterial stiffness, coronary artery calcification and mortality. We speculate that the association between nonthyroidal illness and mortality may be partly mediated by acceleration of vascular calcification.