Frequency of Hypothyroidism among Patients with Chronic Kidney Disease at a Tertiary Care Hospital in Pakistan

Frequency of Hypothyroidism among Patients with Chronic Kidney Disease

Authors

  • Hamid Ullah Department of Medicine, Mardan Medical Complex, Mardan, Pakistan
  • Anees Ahmed Department of Medicine, Mardan Medical Complex, Mardan, Pakistan
  • Manzoor Hussain Department of Medicine, Mardan Medical Complex, Mardan, Pakistan
  • Amjad Ali Department of Medicine, Mardan Medical Complex, Mardan, Pakistan
  • Murad Ali Department of Medicine, Bacha Khan Medical College, Mardan, Pakistan
  • Shahid Shehzad Department of Endocrinology, Bacha Khan Medical College, Mardan, Pakistan
  • Hamza Israr Department of Medicine, Mardan Medical Complex, Mardan, Pakistan
  • Ansa Amin Department of Medicine, Mardan Medical Complex, Mardan, Pakistan
  • Asim Ali Department of Medicine, Mardan Medical Complex, Mardan, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v7i4.3944

Keywords:

Hypothyroidism, Chronic Kidney Disease, Thyroid Dysfunction, Subclinical Hypothyroidism Dialysis, Endocrine Disorders

Abstract

Patients with Chronic kidney disease (CKD) suffer from endocrine axis disruption as a part of the complications involving several other organ systems. Hypothyroidism is one of the imbalances seen in patients with CKD, both in clinical practice and research. Thyroid dysfunction remains undiagnosed due to its non-specific symptoms and lack of routine screening, especially in resource-limited settings. Objectives: To determine the frequency of hypothyroidism among patients with CKD and to differentiate its clinical and subclinical forms. Methods: This cross-sectional (descriptive) study was conducted over a period of six months in the Department of Medicine, Mardan Medical Complex, Khyber Pakhtunkhwa. 131 CKD patients (18-70 years) were recruited by non-probability consecutive sampling. Serum levels of thyroid-stimulating hormone (TSH), free T3, and free T4 were used to evaluate the patient’s thyroid status. Based on serum hormone levels, the patients were categorized into hypothyroidism, subclinical hypothyroidism, or euthyroid states. The data were analysed through SPSS (version 26.0). Results: Out of 131 CKD patients, clinical hypothyroidism was found in 24 (18.3%), while 27 (20.6%) of the patients had subclinical hypothyroidism. Thyroid dysfunction was more common in patients above 60 (p=0.003) and females (p=0.041). A significant association was also found with dialysis status (p=0.006). Conclusions: Hypothyroidism is a prevalent complication in CKD, especially among older and female patients. The study emphasizes the value of routine thyroid screening in all stages of CKD to facilitate early diagnosis and treatment, especially in dialysis-dependent people.

References

Yuasa R, Ohashi Y, Saito A, Tsuboi K, Shishido S, Sakai K. Prevalence of Hypothyroidism in Japanese Chronic Kidney Disease Patients. Renal Failure. 2020 Jan; 42(1): 572-9. doi: 10.1080/0886022X.2020.1777162. DOI: https://doi.org/10.1080/0886022X.2020.1777162

Matsuoka-Uchiyama N, Tsuji K, Sang Y, Takahashi K, Fukushima K, Takeuchi H et al. The Association Between Hypothyroidism and Proteinuria in Patients with Chronic Kidney Disease: A Cross-Sectional Study. Scientific Reports. 2022 Sep; 12(1): 14999. doi: 10.1038/s41598-022-19226-0. DOI: https://doi.org/10.1038/s41598-022-19226-0

Sinjari HY and Ibrahim JM. Thyroid Function Disorders in Patients with Chronic Kidney Disease. Medical Journal of Babylon. 2022 Jan; 19(1): 76-80. doi: 10.4103/MJBL.MJBL_93_21. DOI: https://doi.org/10.4103/MJBL.MJBL_93_21

Kim HJ, Park SJ, Park HK, Byun DW, Suh K, Yoo MH. Subclinical Thyroid Dysfunction and Chronic Kidney Disease: A Nationwide Population-Based Study. BioMed Central Nephrology. 2023 Mar; 24(1): 64. doi: 10.1186/s12882-023-03111-7. DOI: https://doi.org/10.1186/s12882-023-03111-7

Schultheiss UT, Steinbrenner I, Nauck M, Schneider MP, Kotsis F, Baid-Agrawal S et al. Thyroid Function, Renal Events and Mortality in Chronic Kidney Disease Patients: The German Chronic Kidney Disease Study. Clinical Kidney Journal. 2021 Mar; 14(3): 959-68. doi: 10.1093/ckj/sfaa052. DOI: https://doi.org/10.1093/ckj/sfaa052

You AS, Kalantar-Zadeh K, Brent GA, Narasaki Y, Daza A, Sim JJ et al. Impact of Thyroid Status on Incident Kidney Dysfunction and Chronic Kidney Disease Progression in a Nationally Representative Cohort. In Mayo Clinic Proceedings. 2024 Jan; 99(1): 39-56. doi: 10.1016/j.mayocp.2023.08.028. DOI: https://doi.org/10.1016/j.mayocp.2023.08.028

Chourey T, Khan Y, Pakhare AP, Singhai A, Parashar R, Joshi R et al. Magnitude and Predictors of Subclinical Hypothyroidism in Individuals with Impaired Glucose Tolerance. Cureus. 2025 May; 17(5). doi: 10.7759/cureus.83948. DOI: https://doi.org/10.7759/cureus.83948

Delanaye P, Jager KJ, Bökenkamp A, Christensson A, Dubourg L, Eriksen BO et al. CKD: A Call for an Age-Adapted Definition. Journal of the American Society of Nephrology. 2019 Oct; 30(10): 1785-805. doi: 10.1681/ASN.2019030238. DOI: https://doi.org/10.1681/ASN.2019030238

Sumida K, Nadkarni GN, Grams ME, Sang Y, Ballew SH, Coresh J et al. Conversion of Urine Protein–Creatinine Ratio or Urine Dipstick Protein to Urine Albumin–Creatinine Ratio for Use in Chronic Kidney Disease Screening and Prognosis: An Individual Participant–Based Meta-Analysis. Annals of Internal Medicine. 2020 Sep; 173(6): 426-35. doi: 10.7326/M20-0529. DOI: https://doi.org/10.7326/M20-0529

Blute Jr ML, Kucherov V, Rushmer TJ, Damodaran S, Shi F, Abel EJ et al. Reduced Estimated Glomerular Filtration Rate (eGFR < 60 mL/Min/1.73 M2) at First Transurethral Resection of Bladder Tumour Is a Significant Predictor of Subsequent Recurrence and Progression. British Journal of Urology International. 2017 Sep; 120(3): 387-93. doi: 10.1111/bju.13904. DOI: https://doi.org/10.1111/bju.13904

Khan I, Khan J, Hamza A, Anas M, Khan SJ. Frequency of Hypothyroidism in Patients with Chronic Kidney Disease at Ayub Teaching Hospital, Abbottabad. Khyber Journal of Medical Sciences. 2025 Sep; 18(3): 269-75. doi: 10.70520/kjms.v18i3.788. DOI: https://doi.org/10.70520/kjms.v18i3.788

Mariani LH and Berns JS. The Renal Manifestations of Thyroid Disease. Journal of the American Society of Nephrology. 2012 Jan; 23(1): 22-6. doi: 10.1681/ASN.2010070766. DOI: https://doi.org/10.1681/ASN.2010070766

Bando Y, Ushiogi Y, Okafuji K, Toya D, Tanaka N, Miura S. Non-Autoimmune Primary Hypothyroidism in Diabetic and Non-Diabetic Chronic Renal Dysfunction. Experimental and Clinical Endocrinology and Diabetes. 2002; 110(08): 408-15. doi: 10.1055/s-2002-36427. DOI: https://doi.org/10.1055/s-2002-36427

Sheikh FA, Ali ST, Rashid S, Abid K. Frequency of Hypothyroidism Among Chronic Kidney Disease in a Tertiary Care Hospital. Age (Years). 2023; 60: 52-65.

Wang X, Zhao X, Huang X. Association of Subclinical Thyroid Dysfunction with Chronic Kidney Disease: A Systematic Review and Meta-Analysis. Endocrine Research. 2020 Jan; 45(1): 41-9. doi: 10.1080/07435800.2019.1645164. DOI: https://doi.org/10.1080/07435800.2019.1645164

Narasaki Y, Sohn P, Rhee CM. The Interplay Between Thyroid Dysfunction and Kidney Disease. In Seminars in Nephrology. 2021 Mar; 41(2): 133-143. doi: 10.1016/j.semnephrol.2021.03.008. DOI: https://doi.org/10.1016/j.semnephrol.2021.03.008

Raj R, Kumar V, Bhushan D, Biswas R, Ojha VS, Kumar DV. The Prevalence of Thyroid Abnormalities in Patients with Chronic Kidney Disease: A Cross-Sectional Study at a Tertiary Care Hospital. Cureus. 2023 Aug; 15(8). doi: 10.7759/cureus.43065. DOI: https://doi.org/10.7759/cureus.43065

Ellervik C, Mora S, Ridker PM, Chasman DI, CKDGen Consortium. Hypothyroidism and Kidney Function: A Mendelian Randomization Study. Thyroid. 2020 Mar; 30(3): 365-79. doi: 10.1089/thy.2019.0167. DOI: https://doi.org/10.1089/thy.2019.0167

Huang CW, Li BH, Reynolds K, Jacobsen SJ, Rhee CM, Sim JJ. Association Between Hypothyroidism and Chronic Kidney Disease Observed among an Adult Population 55 Years and Older. Medicine. 2020 Apr; 99(17): e19569. doi: 10.1097/MD.0000000000019569. DOI: https://doi.org/10.1097/MD.0000000000019569

Kashif M, Hussain MS, Anis M, Shah PK, Siddiqui Sr MA. Thyroid Dysfunction and Chronic Kidney Disease: A Study among the Northeastern Population of India. Cureus. 2023 May; 15(5). doi: 10.7759/cureus.38700. DOI: https://doi.org/10.7759/cureus.38700

German S, Bhatti S, Waqar T, Lashari S, Mehmood M, Rizwan A et al. Thyroid Dysfunction in Patients with End-Stage Renal Disease: A Single-Center Experience from Pakistan. Cureus. 2025 Jan; 17(1). doi: 10.7759/cureus.76715. DOI: https://doi.org/10.7759/cureus.76715

Echterdiek F, Ranke MB, Schwenger V, Heemann U, Latus J. Kidney Disease and Thyroid Dysfunction: The Chicken or Egg Problem. Paediatric Nephrology. 2022 Dec; 37(12): 3031-42. doi: 10.1007/s00467-022-05640-z. DOI: https://doi.org/10.1007/s00467-022-05640-z

Ansari I, Kumar S, Acharya S, Agrawal S, Saboo K. Thyroid Dysfunction at Different Stages of Chronic Kidney Disease: A Cross-Sectional Study at A Rural Teaching College in Central India. Cureus. 2023 Jul; 15(7). doi: 10.7759/cureus.42130. DOI: https://doi.org/10.7759/cureus.42130

Shantha GP, Kumar AA, Bhise V, Khanna R, Sivagnanam K, Subramanian KK. Prevalence of Subclinical Hypothyroidism in Patients with End-Stage Renal Disease and the Role of Serum Albumin: A Cross-Sectional Study from South India. Cardiorenal Medicine. 2011 Oct; 1(4): 255-60. doi: 10.1159/000332757. DOI: https://doi.org/10.1159/000332757

Cotoi L, Borcan F, Sporea I, Amzar D, Schiller O, Schiller A et al. Thyroid Pathology in End-Stage Renal Disease Patients on Haemodialysis. Diagnostics. 2020 Apr; 10(4): 245. doi: 10.3390/diagnostics10040245. DOI: https://doi.org/10.3390/diagnostics10040245

Tapper M, McGrowder DA, Dilworth L, Soyibo A. Cystatin C, vitamin D, and Thyroid Function Test Profile in Chronic Kidney Disease Patients. Diseases. 2021 Jan; 9(1): 5. doi: 10.3390/diseases9010005. DOI: https://doi.org/10.3390/diseases9010005

Peters J, Roumeliotis S, Mertens PR, Liakopoulos V. Thyroid Hormone Status in Patients with Impaired Kidney Function. International Urology and Nephrology. 2021 Nov; 53(11): 2349-58. doi: 10.1007/s11255-021-02800-2. DOI: https://doi.org/10.1007/s11255-021-02800-2

Bichari W, Khedr E, Sayed H, Elwasly D, Ezzat H. Prevalence of Thyroid Function Abnormalities in Patients with Chronic Renal Failure Under Regular Haemodialysis. The Egyptian Journal of Hospital Medicine. 2020 Jul; 80(1): 594-8. doi: 10.21608/ejhm.2020.90163. DOI: https://doi.org/10.21608/ejhm.2020.90163

Downloads

Published

2026-04-30
CITATION
DOI: 10.54393/pjhs.v7i4.3944
Published: 2026-04-30

How to Cite

Ullah, H., Ahmed, A., Hussain, M., Ali, A., Ali, M., Shehzad, S., Israr, H., Amin, A., & Ali, A. (2026). Frequency of Hypothyroidism among Patients with Chronic Kidney Disease at a Tertiary Care Hospital in Pakistan: Frequency of Hypothyroidism among Patients with Chronic Kidney Disease . Pakistan Journal of Health Sciences, 7(4), 138–143. https://doi.org/10.54393/pjhs.v7i4.3944

Issue

Section

Original Article

Plaudit

Most read articles by the same author(s)

1 2 > >>