Analysis Of Related Risk Factors Of Subclinical Hypothyroidism In Non-dialysis Patients With Chronic Kidney Disease

Research background:With the improvement of people's cognitive level,the diagnostic rate of subclinical hypothyroidism in chronic kidney disease patients is increasing,patients with CKD are prone to various of complications,the most common complication is cardiovascular disease,which is the important factor affecting the prognosis of patients.The study found a clear correlation between subclinical hypothyroidism and cardiovascular events in patients with chronic kidney disease.Clinicians should raise their awareness of subclinical hypothyroidism,and take intervention measures timely,so as to reduce the incidence of cardiovascular disease,improve long-term prognosis and improve the quality of life of patients with chronic kidney disease.Research objectives:To investigate the prevalence and related risk factors of subclinical hypothyroidism in non-dialysis patients with chronic kidney disease.Research methods:The clinical data of non-dialysis patients with chronic kidney disease in the nephrology department of the Frist Hospital of Jilin University from January 2012 to December 2017 were collected.Record the patient's name,gender,age and other general information.According to the patient's general information,we used MDRD simplified formula to calculate the glomerular filtration rate of each patient.According to the guidelines designated by the KDIGO it was divided into 1-5 periods.Collect the patient's white blood cell red blood cell,platelet,hemoglobin of blood routine,serum albumin,cholesterol,triglyceride,high density lipoprotein cholesterol,low density lipoprotein cholesterol,serum sodium,chloride,calcium,phosphorus,iron,total iron binding capacity,iron protein,serum thyroid stimulating hormone,serum free triiodothyronine,free thyroxine,thyroglobulin antibodies and thyroperoxidase antibodies,24 hour urinary protein quantitative and other laboratory indicators.Statistics if the patient has diabetes.Non-dialysis patients with chronic kidney disease were divided into normal thyroid function group and subclinical hypothyroidism group,compared between the two groups in the above indicators,the above data was analyzed by SPSS 22.0 statistical software analysis,statistical methods using Mann-Whitney rank sum test,chi-square test,Logistic regression analysis,P<0.05 was a significant difference.Research results:A total of 447 patients with chronic kidney disease were included in this study,including 335 cases with normal thyroid function and 112 cases with subclinical hypothyroidism,with a prevalence of 25.1%.The prevalence of subclinical hypothyroidism was 27.4% in women and 23.7% in male patients.The above patients were divided into two groups according to whether they reached the age of 60.The prevalence of subclinical hypothyroidism was 21.3% in patients with CKD who were less than 60 years,and was 30.9% in patients 60 years or older.According to the different stages of CKD,they were divided into three groups,the prevalence of subclinical hypothyroidism in patients with stage CKD1-3,CKD4,CKD5 was 16.9%,17.3%,and 28.7%.Among the patients with DM,the prevalence of subclinical hypothyroidism was 28.1%,and 23.6% of patients without DM.Gender distribution,age distribution,DM and CKD staging in two groups of patients were compared by chi-square test: normal group and subclinical hypothyroidism group in gender distribution,whether diabetes compared,no significant difference(P > 0.05);according to whether the age reached 60 years old,it was divided into <60 years old group and ?60 years old group,the difference in age distribution between normal thyroid function group and subclinical hypothyroidism group was statistically significant(P<0.05);there were significant differences between the two groups in CKD 1-3,4 and 5 stages(P<0.05).The laboratory indexes using Mann-Whitney rank sum test: comparison of two groups of white blood cell,red blood cell,hemoglobin,triglyceride,low density lipoprotein cholesterol,potassium,sodium,chloride,calcium,phosphorus,iron,total iron binding capacity,ferritin two groups,the difference was not statistically significant(P>0.05);platelet,serum albumin,cholesterol,high-density lipoprotein cholesterol and 24 hour urine protein were significantly different between the two groups(P<0.05),and serum albumin,cholesterol and high-density lipoprotein cholesterol between the two groups had significant difference(P<0.01).Logistic regression analysis showed that CKD stage,platelet,serum albumin and high-density lipoprotein cholesterol were the influencing factors of subclinical hypothyroidism in non-dialysis CKD patients(P<0.05).CKD stage,platelets and high-density lipoprotein cholesterol are risk factors,and serum albumin is a protective factor.Research conclusions:1.The prevalence of subclinical hypothyroidism in non-dialysis patients with chronic kidney disease is 25.1%,and occurs frequently in people aged more than 60 years.2.Age,glomerular filtration rate,serum albumin,cholesterol,and 24 hour urine protein were associated with subclinical hypothyroidism in non-dialysis patients with chronic kidney disease,and glomerular filtration rate and serum albumin are independent influencing factors.