Kidney medicine · 2026
Thyroid Stimulating Hormone Levels and Risk of Hospital-Acquired Acute Kidney Injury: A Nationwide Cohort Study.
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She Caoxiang, Lin Yaduan, Xie Yanan, Zhou Shiyu, Luo Fan, Chen Ruixuan, Jin Luhua, Li Lantian, Chen Linjiang, Shao Xian, Nie Sheng
Аннотация
RATIONALE & OBJECTIVE: The thyroid-renal interaction remains underexplored in acute kidney injury pathophysiology. We aimed to investigate the relationship between thyroid status, defined by thyroid-stimulating hormone (TSH) levels, and incident hospital-acquired acute kidney injury (HA-AKI).
STUDY DESIGN: A retrospective cohort study.
SETTING & PARTICIPANTS: Patients with TSH quantification within 48 hours after admission from the China Renal Data System (CRDS) database.
EXPOSURES: Three TSH levels groups, including hyperthyroid (TSH ≤ 0.5 mIU/L), euthyroid (0.5 < TSH ≤ 5.0 mIU/L), and hypothyroid (TSH > 5.0 mIU/L) TSH levels.
OUTCOMES: The primary outcome was HA-AKI.
ANALYTICAL APPROACH: Multivariable Cox hazard regression models and restricted cubic spline.
RESULTS: A total of 20,317 (5.4%) patients developed HA-AKI, with incidences rates of 8.0%, 5.0%, and 6.4% in patients with hyperthyroid, euthyroid, and hypothyroid TSH levels, respectively. Compared with patients with euthyroid TSH levels, those with hyperthyroid or hypothyroid TSH levels were associated with an increased risk of HA-AKI (hyperthyroid TSH levels: adjusted hazard ratio [aHR], 1.28; 95% confidence interval [CI], 1.21-1.37; P < 0.001; hypothyroid TSH levels: aHR, 1.10; 95% CI, 1.01-1.21; P = 0.03). Additionally, the dose-response curve showed a U-shaped relationship between TSH levels and the risk of new-onset HA-AKI.
LIMITATIONS: Possible residual confounding.
CONCLUSIONS: TSH levels in the low (≤0.5 mIU/L) and high (>5.0 mIU/L) ranges were associated with increased risk of HA-AKI. These insights suggest that enhanced vigilance toward AKI may be justifiable in patients with thyroid dysfunction.
STUDY DESIGN: A retrospective cohort study.
SETTING & PARTICIPANTS: Patients with TSH quantification within 48 hours after admission from the China Renal Data System (CRDS) database.
EXPOSURES: Three TSH levels groups, including hyperthyroid (TSH ≤ 0.5 mIU/L), euthyroid (0.5 < TSH ≤ 5.0 mIU/L), and hypothyroid (TSH > 5.0 mIU/L) TSH levels.
OUTCOMES: The primary outcome was HA-AKI.
ANALYTICAL APPROACH: Multivariable Cox hazard regression models and restricted cubic spline.
RESULTS: A total of 20,317 (5.4%) patients developed HA-AKI, with incidences rates of 8.0%, 5.0%, and 6.4% in patients with hyperthyroid, euthyroid, and hypothyroid TSH levels, respectively. Compared with patients with euthyroid TSH levels, those with hyperthyroid or hypothyroid TSH levels were associated with an increased risk of HA-AKI (hyperthyroid TSH levels: adjusted hazard ratio [aHR], 1.28; 95% confidence interval [CI], 1.21-1.37; P < 0.001; hypothyroid TSH levels: aHR, 1.10; 95% CI, 1.01-1.21; P = 0.03). Additionally, the dose-response curve showed a U-shaped relationship between TSH levels and the risk of new-onset HA-AKI.
LIMITATIONS: Possible residual confounding.
CONCLUSIONS: TSH levels in the low (≤0.5 mIU/L) and high (>5.0 mIU/L) ranges were associated with increased risk of HA-AKI. These insights suggest that enhanced vigilance toward AKI may be justifiable in patients with thyroid dysfunction.