THE STUDY OF PREVALENCE OF SUBCLINICAL HYPOTHYROIDISM AND ITS CORRELATION WITH SERUM ALBUMIN ON PATIENTS WITH CHRONIC KIDNEY DISEASE

Background: Chronic diseases have emerged as a important contributor to worldwide mortality and morbidity rates. The incidence of chronic kidney disease (CKD) stage-5 is 150–200 per million people and prevalence of CKD is approximately 800 per million people(1). In south Indian CKD patients diabetic nephropathy accounts for 29.6% , chronic interstitial nephritis (20.4%), chronic glomerulonephritis (17.4%), and hypertension nephropathy (11%) (2).It was discovered that CKD was related to a higher frequency of both subclinical and clinical primary hypothyroidism in the 3rd National Health and Nutrition Examination Survey participants. This finding was regarded to be quite interesting. So in our study we would like to see prevalence of subclinical hypothyroidism (SCH) and its relation with serum albumin in CKD patients.

Results:Out of the 100 CKD patients, the mean age was 53.45 ± 12.37 years. The mean of estimated GFR is 12.392 ± 8.81 ml/min per 1.73 m (range, 3 to 54.4 ml/min per 1.73 m ), serum TSH is 9.59 ± 13.11 mIU/L (range, 0.17 to 100.6 mIU/L), and serum creatinine concentrations is 7.23 ± 3.73 mg/dl (range, 0.8 to 1.8 mg/dl).Among the study participants 45 patients (45%) have normal serum thyroid function test results. On the other hand, 54 patients (54%)have subclinical hypothyroidism(SCH).Overall, 5 (5%) patients have eGFR between 30 and 59 ml/min per 1.73 m2, 19 subjects had eGFR of 15 to 30 ml/min per 1.73 m2 and most patients 76 ( 76%) have an eGFR of <15 ml/min per 1.73 m2.The prevalence of subclinical primary hypothyroidism was increased in patients with progressively lower kidney function, ranging from 53.9% for persons with e GFR ≤ 15 ml/min per 1.73 m2 ,63.2% in persons with an eGFR 15-29 ml/min per 1.73 m2 in total stage 4 CKD patients and 20% in patients with eGFR between 30- 59ml/min per 1.73m2.Theserum albumin levels are decreased in 53 of patients with CKD and 47 patients have normal serum albumin levels(3.5- 4.5g/dl).

Conclusions:In conclusion, in our study, the prevalence of SCH in study participants with CKD was 54%. Therefore, it may be wise to check the thyroid functions of all CKD patients regularly. In CKD patients, SCH is related to low serum albumin levels. There have been disagreements regarding whether thyroxine supplementation is necessary for SCH in CKD . Reduced thyroid function may serve as an adaptation for CKD patients to reduce protein catabolism. Therefore, attempts to treat it might be harmful to the patient. The issues surrounding thyroxin replacement in CKD patients with SCH, particularly when accompanied by hypoalbuminemia, may require additional, more extensive randomised trials and long-term follow-up.