Journal of
Clinical Nephrology and Renal Care
Original Article: Open Access
ClinMed
International Library
Citation: Khamis OA, EL Sadek AH, Hegazy AM, Dessouky KM, Abdellatif SS, et al. (2016)
Prevalence of Echocardiographic Abnormalities and its Relation to Thyroid Abnormalities
among Hemodialysis Patients. J Clin Nephrol Ren Care 2:015
Received: August 08, 2016: Accepted: October 17, 2016: Published: October 19, 2016
Copyright: © 2016 Khamis OA, et al. This is an open-access article distributed under the terms
of the Creative Commons Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are credited.
Khamis et al. J Clin Nephrol Ren Care 2016, 2:015
Volume 2 | Issue 2
Prevalence of Echocardiographic Abnormalities and its Relation to
Thyroid Abnormalities among Hemodialysis Patients
Osama A Khamis
1
*, Abdellah H EL Sadek
1
, Amin M Hegazy
1
, Khaled M Dessouky
1
, Salama
S Abdellatif
2
, Ahmed M Fahmy
3
and Mostafa A Alsawasany
3
1
Department of Internal Medicine, Al-Azhar University, Eygpt
2
Department Clinical Pathology, Al-Azhar University, Eygpt
3
Department Cardiology, Al-Azhar University, Eygpt
*Corresponding author: Osama A Khamis, Department of Internal Medicine, Al-Azhar University, Egypt, E-mail:
okhamis2015@gmail.com
Abstract
Background and aim: The kidney is involved in the regulation
of thyroid hormones metabolism. Numerous abnormalities of
thyroid hormones in end-stage kidney disease (ESKD) have been
described. The aim of our study was to estimate the prevalence of
thyroid dysfunction and its relation to Echocardiologic abnormalities
in patients with end stage kidney disease.
Material and method: 60 patients with ESKD on regular hemodialysis
were recruited for this study. All subjects were investigated with
Transthoracic Echocardiography and laboratory tests to determine
thyroid function, including: serum triiodothyronine (T3), free T3, serum
thyroxine (T4), freeT4, thyroid-stimulating hormone (TSH). Results
were compared with the same measurements in 20 normal control
subjects.
Results: The prevalence of thyroid abnormalities (78.3%) and low
T3 (70%). T3 and T4 were signifcantly low (68.6 ± 21.4 ng/dL, 5.1 ±
2.1 µg/dL) compared to control group (104.1 ± 20.2 ng/dL, 7.8 ± 2.0
µg/dL). The prevalence of Echocardiologic abnormalities (71.7%)
and left ventricular hypertrophy (70%). There was signifcant low T3
in patients with Echocardiologic abnormalities. 90.7% in patients
with Echocardiologic abnormalities and 90.5% of patients with left
ventricular hypertrophy had thyroid abnormalities. T3 levels show
negative correlations with LVMI, LVEDD, SWT and PWT and a
positive correlation with LVEF. No signifcant correlations between
FT3, FT4, TSH and Echocardiographic data can be observed
detected.
Conclusion: Echocardiographic abnormalities were linked by thyroid
abnormalities especially low T3. Screening for early detection of
thyroid disorders is useful and important.
Keywords
Echocardiologic abnormalities, Thyroid abnormalities, ESKD
surprising, therefore, that impairment in kidney function leads to
disturbed thyroid physiology [1]. Chronic renal failure afects thyroid
function in multiple way, including low circulating thyroid hormone
concentration, altered peripheral hormone metabolism, disturbed
binding to carrier proteins, possible reduction in tissue thyroid
hormone content, and increase iodine store in thyroid glands. Both
plasma triiodothyronine (T3) and thyroxin (T4) are reduced [2].
Tyroid function has been extensively evaluated in patients
with chronic kidney disease, however the results are variable,
primary hyperthyroidism is extremely rare, while the prevalence of
hypothyroidism is increased in patients with chronic renal failure
[3]. Te prevalence of hypothyroidism was increased in persons
with reduced glomerular fltration rate (GFR), ranging from 5.4%
for persons with estimated GFR ≥ 90 mL/min/1.73 m
2
to more
than 20% in persons with estimated GFR < 60 mL/min/1.73 m
2
[4]. In spite of a large number of previous investigations of thyroid
function abnormalities in end stage kidney disease (ESKD) patients,
the echocardiographic fndings were not included in the analysis in
most of these studies. Terefore, the aim of this study was to evaluate
thyroid function abnormalities and its relation to echocardiographic
abnormalities in ESKD patients.
Patients and Methods
Sixty clinically stable end stage kidney diseasepatients were
enrolled in this cross sectional study. All patients were under regular
hemodialysis at Al-Azhar University Hospital (Hussein Hospital)
between October 2014 and Jun 2015 (4 hours session, thrice weekly),
using polysulfone high fux dialyzer 1.6 m
2
surface area, with dialysate
fow 500 ml/min and dialysate calcium concentration 1.25 mmol/l,
using heparin as anticoagulant with tailored doses according to each
case and bicarbonate based dialysate. Te adequacy of dialysis was
assessed using Kt/V formula. 20 normal individuals were used as
control group.
Patients with the following criteria were excluded: patients
younger than 18 year; patients with congestive heart failure,
respiratory failure, and liver cirrhosis; patients who had a history of
Introduction
Te kidney plays an important role in the metabolism,
degradation and excretion of several thyroid hormones. It is not