{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T13:23:13Z","timestamp":1792070593570,"version":"4.4.0"},"reference-count":55,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2020,6,5]],"date-time":"2020-06-05T00:00:00Z","timestamp":1591315200000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Else Kroener Fresenius Foundation"},{"DOI":"10.13039\/501100001659","name":"German Research Foundation","doi-asserted-by":"crossref","award":["246781735"],"award-info":[{"award-number":["246781735"]}],"id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Collaborative Research Centre"},{"name":"1140 Kidney Disease \u2013 From Genes to Mechanisms"},{"name":"German Federal Ministry of Education and Research"},{"name":"e:Med research and funding concept","award":["01ZX1912B"],"award-info":[{"award-number":["01ZX1912B"]}]},{"DOI":"10.13039\/100004807","name":"DFG","doi-asserted-by":"publisher","award":["246781735"],"award-info":[{"award-number":["246781735"]}],"id":[{"id":"10.13039\/100004807","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004807","name":"DFG","doi-asserted-by":"publisher","award":["CRC 1140 KIDGEM"],"award-info":[{"award-number":["CRC 1140 KIDGEM"]}],"id":[{"id":"10.13039\/100004807","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004807","name":"DFG","doi-asserted-by":"publisher","award":["KO 3598\/5-1"],"award-info":[{"award-number":["KO 3598\/5-1"]}],"id":[{"id":"10.13039\/100004807","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002347","name":"BMBF","doi-asserted-by":"publisher","award":["FKZ 01ER 0804"],"award-info":[{"award-number":["FKZ 01ER 0804"]}],"id":[{"id":"10.13039\/501100002347","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002347","name":"BMBF","doi-asserted-by":"publisher","award":["01ER 0818"],"award-info":[{"award-number":["01ER 0818"]}],"id":[{"id":"10.13039\/501100002347","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002347","name":"BMBF","doi-asserted-by":"publisher","award":["01ER 0819"],"award-info":[{"award-number":["01ER 0819"]}],"id":[{"id":"10.13039\/501100002347","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002347","name":"BMBF","doi-asserted-by":"publisher","award":["01ER 0820"],"award-info":[{"award-number":["01ER 0820"]}],"id":[{"id":"10.13039\/501100002347","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002347","name":"BMBF","doi-asserted-by":"publisher","award":["01ER 0821"],"award-info":[{"award-number":["01ER 0821"]}],"id":[{"id":"10.13039\/501100002347","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Kuratorium f\u00fcr Heimdialyse Foundation"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,3,23]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hypothyroidism and low free triiodothyronine (FT3) syndrome [low FT3 levels with normal thyroid-stimulating hormone (TSH)] have been associated with reduced kidney function cross-sectionally in chronic kidney disease (CKD) patients with severely reduced estimated glomerular filtration rate (eGFR) or end-stage kidney disease (ESKD). Results on the prospective effects of impaired thyroid function on renal events and mortality for patients with severely reduced eGFR or from population-based cohorts are conflicting. Here we evaluated the association between thyroid and kidney function with eGFR (cross-sectionally) as well as renal events and mortality (prospectively) in a large, prospective cohort of CKD patients with mild to moderately reduced kidney function.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Thyroid markers were measured among CKD patients from the German Chronic Kidney Disease study. Incident renal endpoints (combined ESKD, acute kidney injury and renal death) and all-cause mortality were abstracted from hospital records and death certificates. Time to first event analysis of complete data from baseline to the 4-year follow-up (median follow-up time 4.04\u2009years) of 4600 patients was conducted. Multivariable linear regression and Cox proportional hazards models were fitted for single and combined continuous thyroid markers [TSH, free thyroxine (FT4), FT3] and thyroid status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Cross-sectionally, the presence of low-FT3 syndrome showed a significant inverse association with eGFR and continuous FT3 levels alone showed a significant positive association with eGFR; in combination with FT4 and TSH, FT3 levels also showed a positive association and FT4 levels showed a negative association with eGFR. Prospectively, higher FT4 and lower FT3 levels were significantly associated with a higher risk of all-cause mortality (Nevents\u2009=\u2009297). Per picomole per litre higher FT3 levels the risk of reaching the composite renal endpoint was 0.73-fold lower (95% confidence interval 0.65\u20130.82; Nevents\u2009=\u2009615). Compared with euthyroid patients, patients with low-FT3 syndrome had a 2.2-fold higher risk and patients with hypothyroidism had a 1.6-fold higher risk of experiencing the composite renal endpoint.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Patients with mild to moderate CKD suffering from thyroid function abnormalities are at an increased risk of adverse renal events and all-cause mortality over time.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ckj\/sfaa052","type":"journal-article","created":{"date-parts":[[2020,3,18]],"date-time":"2020-03-18T16:11:27Z","timestamp":1584547887000},"page":"959-968","source":"Crossref","is-referenced-by-count":33,"title":["Thyroid function, renal events and mortality in chronic kidney disease patients: the German Chronic Kidney Disease study"],"prefix":"10.1093","volume":"14","author":[{"given":"Ulla T","family":"Schultheiss","sequence":"first","affiliation":[{"name":"Institute of Genetic Epidemiology, Medical Center \u2013 University of Freiburg, Faculty of Medicine, Freiburg, Germany"},{"name":"Department of Medicine IV \u2013 Nephrology and Primary Care, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inga","family":"Steinbrenner","sequence":"additional","affiliation":[{"name":"Institute of Genetic Epidemiology, Medical Center \u2013 University of Freiburg, Faculty of Medicine, Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Nauck","sequence":"additional","affiliation":[{"name":"Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus P","family":"Schneider","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg, Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fruzsina","family":"Kotsis","sequence":"additional","affiliation":[{"name":"Institute of Genetic Epidemiology, Medical Center \u2013 University of Freiburg, Faculty of Medicine, Freiburg, Germany"},{"name":"Department of Medicine IV \u2013 Nephrology and Primary Care, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seema","family":"Baid-Agrawal","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Transplant Center, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elke","family":"Schaeffner","sequence":"additional","affiliation":[{"name":"Institute of Public Health, Charit\u00e9\u2013Universit\u00e4tsmedizin Berlin, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai-Uwe","family":"Eckardt","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg, Erlangen, Germany"},{"name":"Department of Nephrology and Medical Intensive Care, Charit\u00e9\u2013Universit\u00e4tsmedizin Berlin, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"K\u00f6ttgen","sequence":"additional","affiliation":[{"name":"Institute of Genetic Epidemiology, Medical Center \u2013 University of Freiburg, Faculty of Medicine, Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peggy","family":"Sekula","sequence":"additional","affiliation":[{"name":"Institute of Genetic Epidemiology, Medical Center \u2013 University of Freiburg, Faculty of Medicine, Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the GCKD investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,6,4]]},"reference":[{"key":"2021080215344086900_sfaa052-B1","doi-asserted-by":"crossref","first-page":"1888","DOI":"10.1016\/S0140-6736(17)30788-2","article-title":"Global kidney health 2017 and beyond: a roadmap for closing gaps in care, research, and policy","volume":"390","author":"Levin","year":"2017","journal-title":"Lancet"},{"key":"2021080215344086900_sfaa052-B2","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1016\/S0140-6736(13)60439-0","article-title":"Evolving importance 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