Correlation Between Thyroid Function And Autoantibodies And Cardiovascular Disease In Patients With Chronic Kidney Disease Stages 3-5

Background:Chronic kidney disease(CKD)interacts with thyroid disease and cardiovascular disease(CVD).Patients with CKD often suffer from subclinical hypothyroidism(SCH),non-thyroid sick syndrome(NTIS)and autoimmune thyroid diseases(AITD).SCH or NTIS is closely related to the occurrence and development of CVD.Cardiac markers such as cTn,BNP or NT-proBNP and CRP in patients with CKD can be used as independent predictors of adverse cardiovascular events.Echocardiography can be used to evaluate the cardiac function of patients with CKD by LVEF,E/A,E/E',E'/A' and other parameters.However,in patients with CKD stages 3-5,the correlation between thyroid hormones and antibodies and cardiac markers and echocardiographic parameters has not been fully determined.Objective:This research aimed to evaluate the role of thyroid function and autoantibodies in the development of CVD in patients with CKD stages 3-5,and to analyze the correlation between echocardiographic parameters E/A,E/E',E'/A',LVEF and thyroid function and autoantibodiesMethods:The patients who were diagnosed as CKD in our department from January 2015 to May 2019 were recruited.A total of 1164 patients with CKD stages 3-5 were included in this study.There were 598 men and 566 women,of which 340 were stage 3,366 were stage 4,and 458 were stage 5.All subjects were asked for routine medical history and collected general clinical data,including gender,age,height,weight,and other basic information.Laboratory test results were also collected.Echocardiography is performed by a trained echocardiographer and analyzed based on the average of three cardiac cycles to measure mitral valve blood flow velocity(E)in early diastole and Mitral valve flow velocity(A),E/A ratio,mitral annulus velocity(E')in early diastole,mitral annulus velocity(A')in end-diastole,E/E'ratio,and E'/A' ratio.The SPSS 22.0 statistical software was used to analyze the data.Results:1.All patients had anemia,and the degree of anemia became severe with the deterioration of renal function(P<0.001).The triglyceride(TG)of patients in each stage was high,and there were significant differences(P<0.001).2.The prevalence of AITD in each period was statistically different(P=0.001).The prevalence of AITD in CKD stages 3-5 was 11.8%,14.2%,and 21.4%,respectively.3.FT3 was positively correlated with hemoglobin(HGB)(r=0.289,P<0.001),negatively correlated with CRP(r=-0.199,P<0.001),and negatively correlated with TG(r=-0.152,P=0.002).FT4 was positively correlated with HGB(r=0.293,P<0.001)and negatively correlated with TG(r=-0.316,P<0.001).4.Thyroid peroxidase antibody(TPOAb)titers were positively correlated with SCr and BUN(r=0.259,r=0.311,P<0.05),and negatively correlated with eGFR(r=-0.289,P<0.05);Thyroglobulin antibody(TGAb)was negatively correlated with eGFR(r=-0.287,P<0.05);thyrotropin receptor antibody(TRAb)was only observed to be significantly positively correlated with CRP(r=0.206,P<0.001)5.The titers of TPOAb and TGAb in male diabetic patients were higher(r=0.137,P=0.023;r=0.159,P=0.011).In female patients,both TPOAb and TGAb are significantly negatively correlated with HGB(r=-0.213,P=0.018;r=-0.188,P=0.019)6.After adjusting for age and gender,E/A was significantly positively correlated with FT4(r=0.110,P=0.028),and E/E' was significantly negatively correlated with FT3(r=-0.152,P=0.003).The E/E' value of patients with TPOAb positive was higher(r=0.181,P<0.001).LVEF was significantly positively correlated with FT3(r=0.111,P=0.031).The LVEF in patients with TPOAb positive were higher(r=0.159,P=0.007).In addition,LVEF was significantly negatively correlated with TRAb(r=-0.112,P=0.026).Conclusion:The prevalence of AITD in CKD stages 3-5 gradually increases with the decline of renal function,and the titers of TPOAb and TGAb also gradually increase.There may be a common pathway between AITD and CKD.In patients with CKD stages 3-5,NTIS and AITD may accelerate the incidence of CVD in CKD patients by affecting TG levels,accelerating the occurrence of anemia,and promoting the micro-inflammation.Female patients with high titers of TPOAb and TGAb should be paid more attention.Patients with CKD stage 5 have an average E/E 'ratio of 16.Women with low FT3 and TPOAb positive may be more likely to develop diastolic heart failure.