1Associate Professor, Medicine, Saraswathi Institute of Medical Sciences, Anwarpur, Hapur, Uttar Pradesh
2Assistant Professor, Physiology, Saraswathi Institute of Medical Sciences, Anwarpur, Hapur, Uttar Pradesh
3Senior Resident, Department of Pathology, Saraswathi Institute of Medical Sciences, Anwarpur, Hapur, Uttar Pradesh
4Assistant Professor, Medicine, Saraswathi Institute of Medical Sciences, Anwarpur, Hapur, Uttar Pradesh
5Associate Professor, Medicine, Saraswathi Institute of Medical Sciences, Anwarpur, Hapur, Uttar Pradesh
*Corresponding author: Dr Pranay Swarnkar, Assistant Professor, Saraswathi Institute of Medical Sciences, Anwarpur Hapur, 8/41 Chiranjeev Vihar, Ghaziabad 201002, Mob. 9599321321, E-mail- drpranay@ymail.com
Chronic Kidney Disease (CKD) is a disease spectrum characterized by progressive loss of renal function over a period of time. Early identification and management of CKD has been shown to reduce the adverse outcomes, which include kidney failure and cardiovascular disease. Thyroid dysfunction including hypothyroidism, hyperthyroidism and non-thyroidal illness has been reported in CKD patients. Non thyroidal illness or low T3 syndrome has been shown to worsen CKD by increasing cardiovascular morbidity and mortality and has been reported as an independent predictor of the cardiovascular mortality in these CKD patients. There is need to determine the thyroid hormone profiles in these CKD patients and thus prevent the adverse outcomes.
Total 100 Patient were enrolled and subjects were divided in to 2 groups as cases & controls. Cases: 50 patients aged between 40–70 years of having history of chronic kidney disease with serum creatinine > 4.5 mg/dl and urea > 75mg/dl and dipstick test positive for protein with symptoms of chronic renal failure. Results were compared with the same measurements in 50 patients with diabetes mellitus but without CKD.
The subjects were aged between 55 and 68 years (median age was 58±2 years in diabetic patients with CKD and 56±3 years in patients without CKD) and had an evolution of diabetes between 10 and 21 years. Mean of blood urea levels in cases are 94.86±14.24 mg/dl and in controls are 26.50±6.86 mg/dl. The mean of serum creatinine in cases is 5.88±0.72 mg/dl and in controls are 1.04±0.11 mg/dl. The mean of blood urea and serum creatinine is high when compared to the controls. p value is <0.001 which is statistically significant. Mean of T3 levels in cases are 80.26±16.07 ng/dl and in controls are 112.80±11.02 ng/dl. The mean of T4 level in cases is 6.80±0.48μg/dl and in controls is 8.58±0.48 μg/dl. The mean of T4 in all 30 cases is decreased when compared to the controls; p value is <0.001, which is statistically significant. The mean of TSH level in cases are 6.38±0.48μIU/ml and in controls is 3.58±0.86μIU/ml. Mean of TSH in cases increases compare to controls. P value is <0.001. Which is statistically significant. Twelve diabetic patients with CKD (25.50%) had subclinical hypothyroidism, 5 patients (10.2%) had overt hypothyroidism and 10 patients had low T3 syndrome (22.60%).
From the above study we finally concluded that Mean of T3, T4 decreases TSH increases significantly in cases compare to controls. There is need to assay thyroid hormone profiles in patients with CKD stage 3 and above. Studies on thyroid hormone profile on lower CKD stages should also be done.
CKD, TSH, euthyroid, MDRD
