Thyroid dysfunction in patients with advanced chronic kidney disease: focus on hypothyroidism
Volkova A.R., Khalimov Yu.Sh., Dygun O.D., Chentsov M.S., Vishnevsky K.A., Lukichev B.G.
Background: Thyroid dysfunction is common among patients with chronic kidney disease (CKD) and can worsen the course of uremia, contributing to metabolic and cardiovascular complications. However, the nature and frequency of thyroid dysfunction at various stages of CKD, as well as its relationship with clinical and biochemical parameters, remain poorly understood, particularly in patients with advanced disease.
Objective: Examination of thyroid function parameters in patients with advanced CKD and comparative analysis of thyroid status and clinical and laboratory characteristics between patients with early and advanced CKD.
Materials and methods: A single-center, observational, cross-sectional comparative study was conducted. The study included 154 patients with advanced stages (C4–C5) and 179 with early stages (C1–C2). All subjects were tested for thyroid-stimulating hormone (TSH), free T₄ and T₃, thyroid peroxidase antibodies (TPO antibodies), total protein, albumin, creatinine, urea, albumin-corrected total calcium, sodium, potassium, chloride levels, daily proteinuria, and albumin-to-creatinine ratio. Statistical analysis included independent group comparisons, Tukey and Dunn post hoc tests, and Spearman correlation analysis.
Results: The proportion of subjects with elevated TSH levels (≥4.0 mIU/L) was 15.2%. TSH levels were in the high-normal range (2.51–3.99 mIU/L) in 25.8% of subjects. Patients with elevated TSH levels had significantly lower levels of total protein (68.0 vs. 72.0 g/L; p<0.05) and albumin (40.0 vs. 42.0 g/L; p<0.05). A moderate negative correlation was found between free T₃ and creatinine (ρ=-0.310; p<0.001), reflecting an increase in creatinine levels with a decrease in fT₃ levels. When comparing patients with early and advanced stages of CKD, the incidence of subclinical hypothyroidism (SHT) in stages C4–C5 was more than 2-fold higher (p=0.036).
Conclusion: Thyroid dysfunction, primarily subclinical SHT and low T₃ syndrome, is a common comorbidity in CKD, especially in advanced stages. Elevated TSH levels and decreased peripheral hormone levels are associated with impaired protein metabolism. Monitoring thyroid status in patients with CKD C4–C5 appears essential for the early detection and correction of metabolic disorders.
For citations: Volkova A.R., Khalimov Yu.Sh., Dygun O.D., Chentsov M.S., Vishnevsky K.A., Lukichev B.G. Thyroid dysfunction in patients with advanced chronic kidney disease: focus on hypothyroidism. Pharmateca. 2026;33(2):112-117. (In Russ.). DOI: https://dx.doi.org/10.18565/pharmateca.2026.2.112-117
Authors’ contribution: А.R. Volkova, Yu.Sh. Khalimov, K.A. Vishnevsky, B.G. Lukichev – study concept and design. O.D. Dygun, M.S. Chentsov – data collection and processing. O.D. Dygun – statistical analysis. A.R. Volkova, O.D. Dygun – writing and editing.
Conflicts of interest: The authors confirm that they have no conflicts of interest to declare.
Funding: The study was conducted without any sponsorship.
Ethical Approval: The study was approved by the meeting of the Ethics Committee of Pavlov First Saint Petersburg State Medical University on November 28, 2016, protocol No. 75.
Patient Consent for Publication: All patients provided informed consent for the publication of their data.
Authors’ Data Sharing Statement: The data supporting the findings of this study are available upon request from the corresponding author after approval from the principal investigator.
Keywords
chronic kidney disease
subclinical hypothyroidism
thyroid-stimulating hormone
free T3
free T4
low T3 syndrome
creatinine
About the Authors
A.R. Volkova, Dr. Sci. (Med.), Professor, Department of Faculty Therapy with a Course in Endocrinology, Cardiology and the G.F. Lang Clinic, Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia; volkovaa@mail.ru, ORCID: https://orcid.org/0000-0002-5189-9365 (corresponding author)Yu.Sh. Khalimov, Dr. Sci. (Med.), Professor, Honored Doctor of the Russian Federation, Chief Endocrinologist of the Healthcare Committee of the Government of Saint Petersburg, Chief Endocrinologist of the Ministry of Defense of the Russian Federation, Head of the Department of Faculty Therapy with a Course in Endocrinology, Cardiology and the G.F. Lang Clinic, Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia; yushkha@gmail.com, ORCID: https://orcid.org/0000-0002-7755-7275
O.D. Dygun, Cand. Sci. (Med.), Associate Professor, Department of Faculty Therapy with the Course of Endocrinology, Cardiology and the G.F. Lang Clinic, Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia; dod.90@mail.ru, ORCID: https://orcid.org/0000-0001-8991-0323
M.S. Chentsov, Clinical Resident, Department of Faculty Therapy with the Course of Endocrinology, Cardiology and the G.F. Lang Clinic, Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia; michaelchentsov@gmail.com, ORCID: https://orcid.org/0009-0005-1112-146X
K.A. Vishnevsky, Cand. Sci. (Med.), Head of the Dialysis Department, City Nephrology Center, Saint Petersburg Mariinsky City Hospital; Assistant Professor, Department of Internal Medicine, Nephrology, General and Clinical Faculty of Pharmacology with a Course in Pharmacy, North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia; vishnevskii2022@mail.ru, ORCID: https://orcid.org/0000-0001-6945-4711
B.G. Lukichev, Dr. Sci. (Med.), Professor, Department of Propaedeutics of Internal Medicine with the M.D. Tushinsky Clinic, Pavlov First St. Petersburg State Medical University, St. Petersburg, Russia; borislukichev@inbox.ru, ORCID: https://orcid.org/0000-0002-4768-3780
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