P1043CORRELATION OF ANEMIA AND THYROID HORMONES DISTURBANCES IN PATIENTS WITH TYPE 1 DIABETES AND CHRONIC KIDNEY DISEASE
Authors: SAZONAVA ALENA , Mokhort Tatiana , Karlovich Natalia 
Published: June 2020

Abstract

Background and Aims
Impaired thyroid function is a common endocrine pathology among patients with chronic kidney disease (CKD), affecting metabolic parameters, including iron metabolism. The purpose of the study was to investigate potential relationship between thyroid status and iron metabolism profile in patients with type 1 diabetes (T1D) and DKD.

Method
We recruited 155 patients with T1D. GFR was estimated by CKD-MDRD formula. All patients were divided into 3 groups: the group 1 comprised 59 patients with GFR&gt;60 ml/min; group 2-77 patients with GFR&lt;60 ml/min, group 3- 19 patients, receiving renal replacement therapy (RRT). Biochemical parameters, HbA1c, thyroid hormones, iron homeostasis parameters were measured. Nonparametric statistical methods were used. A P-value &lt;0,05 was considered significant.

Results
Groups were matched by age of T1D manifestation, HbA1c, BMI, CKD duration in groups 2 and 3. Duration of T1D differed by groups. Comparative analysis of patients in the subgroups revealed reliable differences in TSH levels only between patients from group 1 (p= 0.009), however, in the whole sample and in RRT patients its levels remained within the reference interval. Groups differed by FT4 values (group 1 - 14.12 (12.70-16.25) pmol / L, group 2 - 14.52 (13.27-16, 21), 3 group - 12.25 (11.38-13.48), p1,2 = 0.143, p1,3 = 0.035, p2,3 = 0.003) and FT3 (1 group - 4.43 (4,02-4.89) pmol / L, 2 group - 4.27 (3.98-4.78), 3 group - 1.43 (1.31-1.57), p1,2 = 0.712, p1,3 = 0.002, p2,3 = 0.012) with a tendency to maximum decrease when receiving RRT. No significant differences were obtained according to the levels of total T4 and T3, TG, Ab-TG, AbTPO. Significant decrease in Ab-R-TSH levels (group 1 - 0.70 (0.44-1.67) IU / l, group 2 - 0.40 (0.30-0.88), group 3 - 0.30 (0.30-0, 52), p1,2 = 0.492, p1,3 = 0.009, p2,3 = 0.035) confirms the absence of the influence of autoimmune component on the genesis of thyroid disorders in patients with CKD. No differences were obtained between groups in terms of serum iron levels and total iron binding capacity. Patients significantly differed in ERYTHROCYTES levels (group 1 - 4.68 (4.41-5.01) 109 / l, group 2 - 4.59 (3.96-4.83), group 3 - 3.84 (3, 32-4.27), p1,3 &lt;0.001, p2,3 &lt;0.001), HEMOGLOBIN (group 1 -139.00 (129.00-154.00), group 2 - 135, 00 (115.50-145.00), group 3 - 115.00 (103.00-124.00), p1,2 = 0.025, p1,3 &lt;0.001, p2,3 &lt;0.001), HCT (1 group - 41.90 (39.20-45.10)%, group 2 - 40.75 (35.65-43.70), group 3 - 36.25 (32.90-41.20), p1,3 &lt;0.001, p2,3 = 0.055), TRANSFERRIN (group 1 - 32.90 (30.80-35.60) μmol / L, group 2 - 31.60 (19.20-35, 45) 3 group - 2.45 (2.14-3.65), p1,2 = 0.049, p1,3 &lt;0.001, p2,3 &lt;0.001) and FERRITIN (1 group - 54.00 (33.00- 74.97) μg / L, group 2 - 74.85 (37.18-109.90), group 3 - 152.60 (92.80-329.60), p1,3 &lt; 0,001, p2,3 = 0.001), which reflects the highest sensitivity of these indicators to decrease in renal function. HCT correlated with levels of total T3 (ρ = 0.489), AbTPO (ρ = -0.490), total T4 (ρ = 0.536). Hb levels correlated with total T4 levels (ρ = 0.811), fT3 (ρ = 0.483). Ferritin levels correlated with fT4 (ρ = 0.510), and transferrin with fT3 (ρ = 0.523). Serum iron levels correlated with AbTPO (ρ = -0.656).

Conclusion
According to revealed changes, possibly anemia contributes to the development of thyroid dysfunctions in patients with diabetic genesis of CKD, due to the involvement of iron in the processes of deiodination and peripheral conversion of thyroid hormones.