Logo image
Back
Thyroid Function with Continuous KRT: A Prospective Study
Journal article   Open access   Peer reviewed

Thyroid Function with Continuous KRT: A Prospective Study

Matthew Kennis, David Madison, North Foulon, Kayo Okamura, Zhibin He, Isadore Budnick, Mark Yoder, Benjamin R Griffin, Benjamin J Kopecky, Melkon DomBourian, …
Kidney360
05/04/2026
DOI: 10.34067/KID.0000001220
PMID: 42081279
url
https://doi.org/10.34067/KID.0000001220View
Published (Version of record) Open Access

Abstract

AKI and ESKD requiring continuous kidney replacement therapy (CKRT) are associated with a high mortality rate. Solutes up to 40 kilodaltons (kDa) in size are amenable to CKRT clearance which includes thyroid stimulating hormone (TSH) (28 kDa), free thyroxine (fT4) (0.78 kDa), and free triiodothyronine (fT3) (0.68 kDa). The effect of CKRT on TSH and thyroid hormone clearance, thyroid function, and the hypothalamic-pituitary-thyroid (HPT) axis is unknown. This prospective, single-center observational study enrolled 50 ICU patients requiring CKRT and 50 control ICU patients. Serum TSH, fT4, fT3, and reverse T3 (rT3) were measured prior to and on days 1, 3, 8, and 14 after CKRT initiation and at the same time points relative to enrollment in control patients; effluent TSH, fT4, and fT3 were measured on days 1, 3, 8, and 14. Thyroid function status was adjudicated on days 1, 3, 8, and 14. Statistical analyses included employment of linear mixed modelling and time-dependent adjustments, and ANOVA with FDR correction. Prior to and during CKRT, CKRT patients had lower fT4 and fT3 levels compared to controls, with a higher proportion of values below the normal reference range. TSH and fT4 were detected in the CKRT effluent, indicating clearance by CKRT. Severe and persistent non-thyroidal illness syndrome (NTIS) was seen in the CKRT cohort. No patient achieved euthyroid status while receiving CKRT. This is the first study to assess thyroid function and clearance of TSH and thyroid hormones during CKRT. We demonstrate that severe NTIS - characterized by low levels of fT4 and fT3 - occurs in the majority of CKRT patients. Furthermore, NTIS is persistent in patients receiving CKRT, which may be influenced by CKRT-mediated TSH and fT4 clearance. These novel complications may contribute to the high mortality rate observed in patients with either AKI or ESKD who receive CKRT.

Details

Metrics

1 Record Views
Logo image