Abstract: FR-PO827
Hypothyroidism (HT) Rate and Testing Among Incident CKD Patients Who Transitioned to Dialysis Within Kaiser Permanente Southern California (KPSC)
Session Information
- Health Maintenance, Nutrition, Metabolism - II
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Health Maintenance, Nutrition, and Metabolism
- 1500 Health Maintenance, Nutrition, and Metabolism
Authors
- Maity, Smita, Kaiser Permanente Southern California, Pasadena, California, United States
- Pak, Katherine J., Kaiser Permanente Southern California, Pasadena, California, United States
- Zhou, Hui, Kaiser Permanente Southern California, Pasadena, California, United States
- Shaw, Sally F., Kaiser Permanente Southern California, Pasadena, California, United States
- Shi, Jiaxiao, Kaiser Permanente Southern California, Pasadena, California, United States
- Rhee, Connie, University of California Irvine, Irvine, California, United States
- Broder, Benjamin, Kaiser Permanente Southern California, Pasadena, California, United States
- Sim, John J., Kaiser Permanente Southern California, Pasadena, California, United States
Background
HT and CKD are highly prevalent conditions with a bidirectional relationship. Among a large diverse real world CKD cohort who transitioned to dialysis, we sought to determine the rate of HT, factors associated with HT, and the overall screening rates for HT
Methods
We conducted a cross-sectional study within KPSC during 2007-2017. Patients aged ≥ 18 years with incident CKD (defined by at least 2 consecutive eGFR less than or equal to 45 at least 90 days apart) who initiated outpatient dialysis (hemodialysis or peritoneal dialysis) were identified. HT was defined as TSH > 4 mlU/L and or use of thyroid replacement medication. The rate of HT and HT screening with TSH measurements were determined. HT rate ratio (RR) and its 95% confidence interval were estimated using multivariable Poisson regressions with Robust error
Results
Among 6,812 CKD patients who transitioned to dialysis 927 (14%) had HT. 50% of incident CKD who initiated outpatient dialysis were screened with a TSH measurement in the 1 year prior to ESKD. Adjusted HT RR (95% CI) were 1.66 (1.19,2.33), 1.73 (1.53,1.95), 1.20 (1.03,1.39), and 1.54 (1.27,1.87) for age ≥ 70 years, females, atrial fibrillation, and weighted Charlson comorbidity index ≥5, respectively. Adjusted HT RR (95% CI) were 1.22(1.05,1.42), 0.62 (0.51,0.75) and 0.75 (0.61,0.93) for non-Hispanic whites, non-Hispanic blacks and Asians, respectively. Heart failure was not associated with HT (Table 2)
Conclusion
Our study observed that 14% of CKD patients who transitioned to dialysis had HT which is higher than the ~5% described among the general population. We observed that only half of CKD patients were screened for HT prior to initiation of dialysis suggesting a potential care gap. Further studies may provide insights into understanding whether greater screening and identification of HT among CKD patients initiating dialysis will lead to improved CKD dialysis related outcomes.