Thyroid Parameters and Kidney Disorder in Type 2 Diabetes : Results from the METAL Study

Copyright © 2020 Yi Chen et al..

OBJECTIVE: Diabetic kidney disease is one of the most common microvascular complications of diabetes mellitus. We aimed to analyze the association of thyroid parameters with kidney disorders, especially in euthyroid participants.

METHODS: The data were obtained from a cross-sectional study, the METAL study. Thyroid parameters, including thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4), triiodothyronine (T3), thyroxin (T4), thyroid peroxidase antibody (TPOAb), and thyroglobulin antibody (TgAb), of 4136 participants with type 2 diabetes were measured. Two structure parameters of thyroid homeostasis, including the sum activity of step-up deiodinases (SPINA-GD) and thyroid secretory capacity (SPINA-GT), and two pituitary thyrotropic function indices, including Jostel's TSH index (TSHI) and the thyrotroph thyroid hormone resistance index (TTSI), were also calculated. Kidney disorders were described according to the presence of reduced estimated glomerular filtration rate (eGFR) and/or higher urinary albumin to creatinine ratio (UACR).

RESULTS: The prevalence of kidney disorders increased with decreasing FT3 or T3 and increasing FT4 or T4 quartile levels (all P < 0.05). After full adjustment, linear regression showed that UACR levels were negatively associated with FT3 and T3 (P < 0.001). In addition, eGFR was positively associated with FT3 and T3 and was negatively associated with TSH and FT4 levels and TgAb positivity (all P < 0.05). By using binary logistic regression, higher TSH and FT4 and lower FT3 and T3 were associated with kidney disorders (all P < 0.05). Similar results were seen in sensitivity analyses, which were performed in 3035 euthyroid diabetic participants; however, TSH was no longer related to them. The area under the receiver operating characteristic curve (AUROC) of lower FT3 for existing kidney disorder was greater than that for any other thyroid hormones (all P < 0.001). The cutoff value of FT3 for reduced eGFR was 4.39 pmol/L. Regarding thyroid homeostasis parameters, SPINA-GD was negatively associated with three statuses of kidney disorders, and TSHI and TTSI were positively associated with reduced eGFR (all P < 0.05).

CONCLUSIONS: Among patients with type 2 diabetes, elevated TSH and FT4 (or T4), lower FT3 (or T3), TgAb positivity, lower SPINA-GD, and higher TSHI and TTSI were associated with kidney disorders. The lower FT3, even within the normal range (<4.38 pmol/L), may be the factor most related to reduced eGFR compared with other thyroid hormones in diabetic patients.

Medienart:

E-Artikel

Erscheinungsjahr:

2020

Erschienen:

2020

Enthalten in:

Zur Gesamtaufnahme - volume:2020

Enthalten in:

Journal of diabetes research - 2020(2020) vom: 06., Seite 4798947

Sprache:

Englisch

Beteiligte Personen:

Chen, Yi [VerfasserIn]
Zhang, Wen [VerfasserIn]
Wang, Ningjian [VerfasserIn]
Wang, Yuying [VerfasserIn]
Wang, Chiyu [VerfasserIn]
Wan, Heng [VerfasserIn]
Lu, Yingli [VerfasserIn]

Links:

Volltext

Themen:

06LU7C9H1V
9002-71-5
9010-34-8
Autoantibodies
Journal Article
Q51BO43MG4
Thyroglobulin
Thyrotropin
Thyroxine
Triiodothyronine

Anmerkungen:

Date Completed 16.02.2021

Date Revised 14.04.2022

published: Electronic-eCollection

Citation Status MEDLINE

doi:

10.1155/2020/4798947

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

NLM309213827