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The association between thyroid function and nutritional status in patients with end-stage renal disease on hemodialysis

Walid Shehab-Eldin
Mohamed Ahmed Shaaban
Mai Abdel Samed Atia


Introduction: Malnutrition is common in patients with End-Stage Renal Disease (ESRD) on hemodialysis (HD) which significantly affects their quality of life. ESRD is associated with thyroid dysfunction which may affect morbidity and mortality. Changes in thyroid function in this population could be a marker of malnutrition. Our aim was the assessment of the nutritional status of patients with ESRD on HD and its association with thyroid function.

Methods: A cross-sectional study was conducted on 84 patients with ESRD on HD. Nutritional status was assessed by anthropometric measurements and Subjective Global Assessment (SGA) Score. Serum FT3, FT4, and TSH concentrations were determined. CBC, kidney function tests, serum albumin, serum iron, total iron-binding capacity, serum cholesterol, and CRP were measured. Patients’ comorbidity status was determined using the Charlson Comorbidity Index (CCI).

Results: The mean SGA score for studied patients was 13.73 ± 4.4, mean values of thyroid functions were: TSH 2.99 ± 2.93uIU/ml; FT4 1.08 ± 0.21 ng/dl and FT3 2.55 ± 0.52 pg/ml. According to SGA score, 26.2% of patients had normal nutritional status, 69% had mild to moderate malnutrition and 4.8% had severe malnutrition. SGA had significant negative correlation with FT3, while there was no significant correlation between it and FT4 or TSH. Serum FT3 concentration inversely correlated with age (r = −0.25, P= 0.02), CCI (r = −0.48, P= 0.0001), CRP (r = −0.46, P= 0.0001), and SGA (r = −0.49, P= 0.0001), and positively correlated with serum albumin (r = 0.47, P= 0.0001). In multivariate regression analysis, SGA was independently associated with FT3 (β, −1.36; 95% confidence interval, −2.5 to −0.2, P= 0.02)

Conclusions: Malnutrition is prevalent among patients with ESRD on HD. FT3 is a marker of malnutrition and could be used as an accessible and reproducible periodical method to detect such states.