Effect of Levothyroxine on Kidney Function in Chronic Kidney Disease with Subclinical Hypothyroidism in US Veterans: A Retrospective Observational Cohort Study

Introduction Chronic kidney disease (CKD) may be associated with overt or subclinical hypothyroidism [SCH; defined as elevated serum thyroid-stimulating hormone (TSH) despite normal free thyroxine levels). Although some studies have demonstrated that thyroid replacement therapy may improve renal fun...

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Bibliographic Details
Published in:Advances in therapy 2021-02, Vol.38 (2), p.1185-1201
Main Authors: Hennessey, James V., Weir, Matthew R., Soni-Brahmbhatt, Seema, Duan, Yinghui, Gossain, Ved V.
Format: Article
Language:English
Subjects:
Aged
Cardiology
Cohort Studies
Endocrinology
Health technology assessment
Humans
Hypothyroidism - complications
Hypothyroidism - drug therapy
Internal Medicine
Kidney
Male
Medicine
Medicine & Public Health
Oncology
Original Research
Pharmacology/Toxicology
Renal Insufficiency, Chronic - complications
Renal Insufficiency, Chronic - drug therapy
Retrospective Studies
Rheumatology
Thyrotropin
Thyroxine - therapeutic use
Veterans
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Summary:Introduction Chronic kidney disease (CKD) may be associated with overt or subclinical hypothyroidism [SCH; defined as elevated serum thyroid-stimulating hormone (TSH) despite normal free thyroxine levels). Although some studies have demonstrated that thyroid replacement therapy may improve renal function in overt hypothyroidism, there is no consensus on its benefits in SCH. Clinical and limited economic outcomes were evaluated in levothyroxine-treated US veterans with CKD + SCH. Methods Veterans Health Administration claims data from April 2013 to March 2018 for levothyroxine-treated versus nontreated CKD + SCH patients were compared. Eligible patients with CKD + SCH (≥ 2 elevated TSH values recorded; ≥ 2 normal thyroxine values recorded) had ≥ 1 TSH values recorded during 24-month follow-up, and ≥ 1 estimated glomerular filtration rate (eGFR) measurement during baseline and follow-up. Continuous levothyroxine use (treatment cohort) was required during follow-up. The primary endpoint was eGFR at 6, 12, 18, and 24 months; secondary endpoints included eGFR change from baseline, CKD progression, and length of hospital stay (LOS). Propensity score matching (PSM) was performed. Results Of 453 eligible patients, 157 remained in each cohort after PSM. Most were male (96%) and white (88%); mean age was 75 years. No significant differences were observed between cohorts at any time point for eGFR, eGFR change from baseline, or CKD progression. Treated patients had numerically higher mean eGFR at 6 and 12 months, lower proportions of progression to higher CKD stages at 12, 18, and 24 months, and shorter mean all-cause LOS versus nontreated patients (1.92 vs. 3.30 days; P  = 0.3483) within the 24-month follow-up period. A significantly shorter mean CKD-related LOS was observed versus nontreated patients (0.11 vs. 1.38 days; P  
ISSN:0741-238X
1865-8652
DOI:10.1007/s12325-020-01589-3