Patients with non-dialysis-dependant chronic kidney disease (NDD-CKD) and dialysis-dependant chronic kidney disease (DD-CKD) frequently also suffer from thyroid disorders, especially hypothyroidism which is found two to five times more often among them compared to the general population. Emerging research has illustrated the potential prognostic implications of this association as NDD-CKD and DD-CKD patients with hypothyroidism have been shown to have higher mortality rates, and treatment of subclinical hypothyroidism in NDD-CKD patients has been reported to attenuate the decline of glomerular filtration rate over time. This review illustrates the bidirectional, multi-layered interplay between the kidneys and the thyroid gland explaining how pathologies in one organ will affect the other and vice versa. Additionally, it outlines the impact of thyroid disorders on routine parameters of kidney function (especially serum creatinine and serum cystatin C) that nephrologists should be aware of in their clinical practice. Lastly, it summarizes the emerging evidence from clinical studies on how treatment of subclinical hypothyroidism in NDD-CKD and DD-CKD patients may potentially have beneficial effects on kidney function as well as mortality. While most of the research in this area has been performed on adult patients, we specifically discuss what is currently known about thyroid dysfunctions in paediatric CKD patients as well and provide management suggestions. The evidence accumulated so far clearly indicates that further, prospective studies with meticulous methodology are warranted to refine our understanding of thyroid disorders in paediatric and adult CKD patients and establish optimal treatment pathways.
Thank you for your post Helvella as a family member has chronic kidney disease and is hypo and also diabetic, and now has heart failure. so many contradictions from hypothyroidism and diabetes with being autoimmune diseases, awful diseases with all the different ailments related to having a thyroid condition
Yes it does, just even the acknowledgment of the connections is something albeit more help and and treatment should be available to us to get as optimal as we can to try to help avoid getting to the point of these added conditions becoming a high risk on top of what is a already extremely complex condition, if no help is given to support a poorly thyroid in regards to the correct meds and support other than just levo, I think thyroid conditions not managed properly with the right medication causes so many of these add ons to our health if not doing so good on levo. Fo kidney specialist even acknowledge the the link between thyroid & kidney disease as nothing was even mentioned to my relation years ago when diagnosed only the diabetes link
I’ve seen this connection. I have elevated creatinine levels and low FT3 giving me indication CKD3 and it’s purely based on my creatinine level as nothing else is abnormal and scan showed all ok too with my kidneys … my first blood test on Liothyronine (only 4wks in) lowered my my creatinine a touch bringing me to high end CKD2.
I’m yet to see if creatinine has gone any lower but my FT3 was still low so I’m not expecting miracles … I’ll be posting an update and asking opinions after my next blood tests.
As last tests my TSH was suppressed and FT3 & 4 still low.
Still altering my medication so will post a more comprehensive query in few weeks.
My local lab changed the EGFR calculation recently (I believe this is happening nationwide) from MDRD to CKD-EPI. The difference for me on my last test =
CKD-EPI.................................>90
If they'd still been using MDRD it would have been 83
I would be very interested to hear if your EGFR continues to be better when taking T3 if you don't mind.
I had my u&e results back yesterday along with my thyroid results etc.So regardless of taking Liothyronine, this time my creatinine has increased from 90 last time to 94 so tipped me back to CKD3a, however my FT3 readings are lower than last time also … make of that what you will.
I eat lower protein day before the test and make sure I’m hydrated also, as was told these can make creatinine levels higher.
Results;
Serum creatinine 94umol/L [45.0-84.0]
eFRG using creatinine (CKD-EPI) per1.73square metres 59 mL/min/1.73m^2
My surgery states Abnormal but expected, no further action.
I’ll be posting a query regarding my results with my results/ranges, after speaking to my endocrinologist as I had my results done at my surgery this time so I’m in process of copying them in email to him.
I'm sorry you've dipped back into CKD 3a. FT3/EGFR??? If nothing else........we have to learn patience with these things don't we.
Have you had UACR (UrineAlbumin to Creatinine Ratio) tested? I keep meaning to ask my GP for this, as it is considered a good 'marker' by KDIGO, and I think it's important.
Yes, I have this annually too.Here’s my results from 29th June 2022.
Urine creatinine 7.31 mol/L
Urine albumin level 8.9 mg/L
Urine/creatinine ratio 1.2 mg/mol [0.0-3.0]
ACR is consistent with ACR category A1-normal ACR
All my U & E serum tests are all good bar creatinine … I had kidney scan some years ago all fine, my creatinine has been higher but 90 previously was best for a while and coincidentally when starting Liothyronine and best FT3 I’ve ever had.
My muscular problems subsided quite a bit, but I’m still getting some annoyances but still low FT3 and suppressed TSH now, going around in circles and TSH chasing and altering medication unfortunately.
I had read papers of muscular problems (Hoffman’s syndrome) with low thyroid markers although many had other inflammatory markers, I haven’t, only thyroid antibodies, which was done in February this year for first time in nearly 9 yrs 🤦🏻♀️
I’ll do a post with my tests results and areas of concern regarding thyroid health.
I obviously have malabsorption issues my diet or should rephrase nutrition is excellent, my Vitamin D has gone down also ferritin and folate they could be a lot better.
These were better in before so maybe correlations in why my thyroid meds aren’t doing as well as they should is only explanation, so I feel small level of supplementing all the time might have to be on the cards.
I have one abnormality
Mean cell haemoglobin concentration 305g/L [315.0-345.0]
but overall state’s for FBC -normal, no further action.
I’m asking about this as periodically suffered and had to take lots of iron medication over past decade… most likely my coeliac disease and malabsorption, although is extremely well controlled, but I had unrecordedable high levels of antibodies initially apparently, and was seeing gastroenterologist for over 2yrs every fortnight at first he thought refractory disease, and they never thought I’d get my levels to negative all the while I felt absolutely fine 🤷🏻♀️
I have now reversed those and lots of things, on the way.
I’ve taken keen interest in nutrition ever since and now hormones is an area I’m looking at as perimenopausal too 🤦🏻♀️ which all plays part one off another likely 🙄
Interesting article thanks. The fact they state the relationship is bi-directional suggests that the chicken /egg argument is far from resolved but it's agreed at least that there is a relationship between thyroid and kidney function and vice versa. If I had to guess though I'd say thyroid affects kidney as it makes logical sense, and the fact that treating subclinical hypo can attenuate declining kidney function fits with that doesn't it? The relationship is bound to be complex but specialists unfortunately don't treat patients holistically. Whilst I was becoming hypothyroid but it hadn't yet been detected, I suffered an AKI which the kidney specialist tried to tell me showed my kidneys were going into decline and it was irreversible . Shortly afterwards my TSH was found to be 161, by a different Dr, and after starting levo my kidney function improved and has returned to normal. The kidney Dr wouldn't discuss the thyroid 's impact on other organs when I brought it up, and clearly had no interest in thyroid (or knowledge probably). He should perhaps read the study you've posted.
I had AKI last year (due to blood pressure meds). It knocked me for six.........so I hate to imagine how you felt with a TSH of 161 on top of that. I was very slightly over-medicated at the time, and had not long been diagnosed coeliac. Glad you recovered......I did too. AKI - Adding Insult to Injury NCEPOD (2009) is damning.
I did a stack of reading........and chicken/egg was a regular theme. I was also concerned that in a lot of the documents I read, in the latter CKD stages under range FT3 is almost a given, but isn't treated because surveys indicate that there isn't any improvement in QoL. Add that to the opinion that low FT3 is the bodies way of protecting itself when acutely ill...............but completely ignore the importance to the heart/brain etc 🤦♀️💣. Cost is what it is.
Hi Nellie. I was wondering which BP meds caused you the AKI? Was it Ramipril by any chance as I was given it before being diagnosed hypo and I had a very bad reaction (angioedema) and I think it contributed to the AKI. I'm scared off BP meds now as they all have side effects listed which I'd prefer to avoid, but I'm being pressured to take them as my BP can be high at times. I was hoping that being on levo might bring it down but it hasn't as yet.
No, I was initially prescribed Ramipril, but I wasn't on it very long because I got the cough. It was combination of Losartan & Indapamide that did it for me. I'd been on Losartan for years, then I had an increase in dose from 75mg to 100mg, swiftly followed by the addition of Indapamide, and my EGFR dropped from 85 to 29 in about 10 days. I'm now on 5mg Amlodipine for the past year.
I think you are very likely right that Ramipril/angioedema contributed to your AKI. Meds,......mainly BP meds are the 3rd biggest cause of AKI behind major surgery, and something I can't remember.
Can I ask what your EGFR was when you had AKI, and whether you were admitted to hospital?
I too need to look at BP meds again, because Amlodipine has affected my gums......not badly......so not urgent, but I asked my GP if they had 24hr BP monitors a few days ago.
GP: Yes we do, but I think there's a problem with the software. I'll get the practice Health Assistant to call you and let you know. (The way he said this made me think that this had been an issue for quite a while, and wasn't likely going to be fixed any time soon).
Me: And what if the HA calls me just to say its not working?
GP: Er, Er I'll have to call you to discuss.
HA called yesterday. Apparently the software issue is that they can't get it to work on anybody else's computer.......and she now works in Admin every other day, so there's nobody to take it off, but we can lend you a bog standard monitor if you haven't got one.
Me: No, thankyou I've got one.
HA: OK I'll chase up the tech, but I'm on holiday next week.🤦♀️
To me, it's just another illustration of why the whole body system needs to be addressed naturally rather than individual diseases with medication - or even specific diets eg kidney.
For my mum (CKD 3), we do this and her improvement has been remarkable eg eGFR from 36 to 76 in recent years. We haven't paid much attention to her thyroid other than monitoring some basic markers.
Thank you for posting helvella. When first undertreated for hypo (doc medicating by TSH) I received a letter from the surgery asking me to see the practice nurse about my AKI. I was in a state of shock and GFR was 58. I read about AKI and thanks to this site soon realised I needed more Levo. My GFR remained at 58 until I was eventually allowed to have some T3 with my levo. Needless to say my most recent GFR was 72, quite a turn around!!
I now know I am a poor converter of T4 to T3 so without Liothyronine I am sure my kidney function would have continued to decline.
It really is time that "silo" thinking in the health service came to an end. Lack of sufficient thyroid hormones affects so many systems in the body and no doubt our own particular genetics will decide which systems are worst affected.
This is very interesting, in traditional Chinese medicine they say that thyroid disorders are because of a kidney deficiency and they will do acupuncture on the kidney points. It probably explains why I always feel so much better having regular acupuncture with a TCM practitioner.
There is definitely some connection, but the chicken and egg conundrum tends to muddy the waters. Although the NHS, and probably other healthcare systems, works in silos rather than holistically, there are some medical professionals who have a more open approach. One such consultant was the kidney specialist summoned to see my partner when he had an emergency call to attend A&E due to deranged kidney test results. After undergoing tests and treatment, with further appointments in the department booked, the consultant discussed various results, which included thyroid levels. My partner is hypothyroid, but had stopped taking his levo, with the knowledge of his GP, about a month previously. In that short time his TSH had risen from optimal to over 100, which greatly concerned the consultant, who instructed him to start taking his levo again immediately with a target level of 1 to reach and maintain, as this was the level necessary, they said, to protect his kidney function, which had drastically deteriorated. It took about 3 months or more for his TSH to stabilise at the required level, but he was left with damaged kidney function. Fortunately, with the help of information gained researching CKD his eGFR is slowly improving. Unfortunately, the kidney consultant's target of a TSH of 1 was an oral instruction, and a recent consultation with an endo has resulted in a TSH target of 4.2 actually being written into his notes! More GPs battles to come over his level, I fear.
The very phrasing implies that there is a resolution - as in a classic riddle or other puzzle. I don't think there is without taking the question out of its obvious context.
This appears to be quite a common occurrence, with many people discovering conditions and diagnoses that they were previously unaware of now that they have easy access to historic results. CKD is also often overlooked, with no advice or treatment given until a serious stage requiring intervention is reached. This is in total contrast to diabetes, where the merest hint of abnormality in glucose levels results in further tests, treatment and ongoing monitoring. Do your research on kidney disease, as there is a lot of help out there, and it can be stabilised or even reversed in some cases.
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