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Thyroid ; 23(5): 552-61, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23189968

RESUMO

BACKGROUND: Although thyroid diseases exist in patients with renal failure, thyroid function tests are not routine tests in patients on chronic hemodialysis (HD). Therefore, the impact of thyroid diseases on erythropoietin (EPO) dosage in HD patients is not well defined. This study evaluated the relationship between the dose of EPO and the presence or absence of thyroid dysfunction in HD patients. METHODS: This study included 1013 adult patients on HD who did not have a malignancy, liver cirrhosis, thalassemia, iron deficiency, gastrointestinal bleeding, or a major operation within 6 months. Patients were characterized as being euthyroid, or having the sick euthyroid syndrome, primary hypothyroidism, subclinical hypothyroidism, hyperthyroidism, or subclinical hyperthyroidism based on thyroid function tests. Routine biochemistry profiles including an index of the efficiency of HD, along with clinical data over the previous 6-month period, were collected and analyzed. Multiple regression models were employed to assess the relationship between the dose of EPO and the presence or absence of thyroid status. RESULTS: The mean monthly EPO dosages were 77.7±37.0, 70.2±40.6, 90.8±68.4, 78.5±46.7, and 82.3±41.2 µg, respectively, in the sick euthyroid syndrome, euthyroid patients, hypothyroidism, subclinical hypothyroidism, and subclinical hyperthyroidism groups (p<0.05). After adjustment of all other variables in multiple regression, the mean monthly EPO dosage was 19.00±8.59 µg more in hypothyroid patients compared with euthyroid patients (p=0.027). Further, considering an interaction with the presence of diabetes, the mean monthly EPO dosage in patients with either hypothyroidism or subclinical hypothyroidism and diabetes was 54.66±17.12 µg (p=0.001) and 31.51±10.38 µg more than that of euthyroid patients, respectively (p=0.002). CONCLUSIONS: In HD patients, the EPO dosage required to maintain the target hemoglobin level is significantly higher in patients having both hypothyroidism or subclinical hypothyroidism and diabetes than in euthyroid patients.


Assuntos
Nefropatias Diabéticas/complicações , Eritropoetina/administração & dosagem , Hematínicos/administração & dosagem , Falência Renal Crônica/complicações , Diálise Renal/efeitos adversos , Doenças da Glândula Tireoide/complicações , Glândula Tireoide/fisiopatologia , Idoso , Anemia Hemolítica/etiologia , Anemia Hemolítica/prevenção & controle , Estudos Transversais , Nefropatias Diabéticas/fisiopatologia , Nefropatias Diabéticas/terapia , Monitoramento de Medicamentos , Eritropoetina/uso terapêutico , Síndromes do Eutireóideo Doente/complicações , Síndromes do Eutireóideo Doente/epidemiologia , Síndromes do Eutireóideo Doente/fisiopatologia , Feminino , Hematínicos/uso terapêutico , Humanos , Hipertireoidismo/complicações , Hipertireoidismo/epidemiologia , Hipertireoidismo/fisiopatologia , Hipotireoidismo/complicações , Hipotireoidismo/epidemiologia , Hipotireoidismo/fisiopatologia , Falência Renal Crônica/fisiopatologia , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Prevalência , Proteínas Recombinantes/administração & dosagem , Proteínas Recombinantes/uso terapêutico , Índice de Gravidade de Doença , Taiwan/epidemiologia , Doenças da Glândula Tireoide/epidemiologia , Doenças da Glândula Tireoide/fisiopatologia
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