Autori: Giuseppe Stefano Netti (1,2), Mario Rotondi (3), Adelaide Di Lorenzo (2), Domenico Papantonio (2), Antonino Teri (2), Morena Schirone (2), Barbara Infante (2), Federica Spadaccino (1), Loreto Gesualdo (4), Elena Ranieri (1), Giovanni Stallone (2), Giuseppe Grandaliano (2).
Affiliazioni: (1) Clinical Pathology Unit and Center for Molecular Medicine, Dept. of Medical and Surgical Sciences, University of Foggia, Foggia (Italy); (2) Nephrology Dialysis and Transplantation Unit, Dept. of Medical and Surgical Sciences, University of Foggia, Foggia (Italy); (3) Internal Medicine and Endocrinology Unit, Laboratory for Endocrine Disruptors, ICS Maugeri I.R.C.C.S, University of Pavia, Pavia (Italy); (4) Nephrology Dialysis and Transplantation Unit, Dept. of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, Bari (Italy).
End-stage renal disease (ESRD) is a condition associated with a broad spectrum of morphological and functional thyroid disorders. Recent studies have shown that low free tri-iodothyronine (fT3) levels are related to inflammatory status and endothelial activation in ESRD patients, leading to higher mortality in dialysis patients. However, there are limited data about a possible relationship between dialysis regimen, namely long nocturnal hemodialysis (LNHD), and thyroid function parameters.
In a retrospective cohort study, 220 incident chronic hemodialysis patients treated during an 8-years period (Jan-2010 Dec-2017) in a single italian dialysis center were enrolled. The main clinical and hematochemical parameters, including thyroid function, were evaluated and related to main patient outcomes.
Patients with low fT3 levels (<3 ng/ml) showed significantly lower survival rates than patients with normal fT3 levels (>3 ng/ml) (8,0% vs 29,7%, p<0,05), although there were no substantial differences in the demographic and clinical characteristics between two groups. After dividing all the cohort study in two groups according to the dialysis regimen (diurnal, n=195; nocturnal, n=25), LNHD patients showed significantly higher survival rates and lower incidence of cardiovascular events than patients on diurnal dialysis. Moreover an 8 years time-depended analysis of thyroidal status showed a significant improvement of fT3 levels in LNHD patients, while fT3 levels were substantially stable in patients on diurnal dialysis (ANOVA p<0.05).
Our data suggest that the application of alternative dialysis regimens, improving micro-inflammation involved in low fT3 syndrome pathogenesis, could improve outcomes and therefore reduce the incidence of cardiovascular events in hemodialysis patients.