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논문분류	춘계학술대회 초록집
제목	The Impact of Low Triiodothyronine Levels on Mortality is Mediated by Malnutrition and Cardiac Dysfunction in Incident Hemodialysis Patients
저자	Hyang Mo Koo1, Eun Jin Kim1, Jae Hyun Han1, Ji Suk Han1, Jung Tak Park1,Hyung Jung Oh1, Seung Hyeok Han1, Tae-Hyun Yoo1, Yong-Lim Kim2,Yon Su Kim3, Chul Woo Yang4, Nam-Ho Kim5, Shin-Wook Kang1
출판정보	2013; 2013(1):
키워드	T3 감소, 영양 실조, 심장 기능 부전/Low T3, Malnutrition, Cardiac dysfunction
초록	Background: Accumulating evidence has indicated that a reduced triiodothyronine (T3) levels in prevalent hemodialysis (HD) patients is a prognostic factor for adverse clinical outcome rather than an innocent bystander. However, little is known whether low T3 is also associated with mortality in end-stage renal disease (ESRD) patients starting HD and whether the impact of T3 on mortality is mediated by malnutrition, inflammation, and cardiac dysfunction in these patients. Methods: A prospective cohort of 471 incident HD patients from 36 dialysis centers of the Clinical Research Center for ESRD in Korea was selected for this study. Based on the median value of T3 concentrations, patients were divided into ‘high’ and ‘low’ groups, and all-cause and cardiovascular (CV) mortality were compared between the two groups. In addition, the associations of T3 levels with various nutritional, inflammatory, and echocardiographic parameters were clarified. Results: Compared to the ‘high’ T3 group, serum albumin, total cholesterol, and triglyceride concentrations, lean body mass estimated by creatinine kinetics (LBM-Cr), and normalized protein catabolic rate (nPCR) were significantly lower in patients with ‘low’ T3. Moreover, the ‘low’ T3 group had significantly higher left ventricular mass index (LVMI) and significantly lower LV ejection fraction (LVEF). Furthermore, correlation analysis revealed significant associations of T3 levels with nutritional and echocardiographic parameters. All-cause and CV mortality rates were significantly higher in patients with ‘low’ T3 compared to the ‘high’ T3 group (113.4 vs. 18.2 events per 1000 patient-yr, p<0.001, and 49.8 vs. 9.1 events per 1000 patient-yr, p=0.001, respectively). Kaplan-Meier analysis also showed significantly worse cumulative survival rates in the ‘low’ T3 group (p<0.001). On Cox proportional hazards regression analysis, ‘low’ T3 was a significant independent predictor of all-cause mortality (Hazard ratio=3.76, 95% Confidence interval=1.06-13.38, p=0.021), even after adjusting for traditional risk factors. However, the significant independent impact of low T3 on all-cause mortality disappeared when LBM-Cr, nPCR, LVMI, or LVEF were incorporated in the successive Cox models. Conclusion: ‘Low’ T3 is a significant independent risk factor for all-cause mortality in incident HD patients, and its impact on mortality may be attributed, in part, to malnutrition and cardiac dysfunction.
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