Treatment for non-thyroidal illness syndrome in advanced chronic kidney disease: a single-blind controlled study

• Published in: Journal of nephrology 2017-08, Vol.30 (4), p.557-565
• Main Authors: Yan, Wenjun, Wang, Lijuan, Huang, Tianlun, Xu, Gaosi
• Format: Article
• Language: English
• Subjects: Acetylcysteine - adverse effects; Acetylcysteine - therapeutic use; Chi-Square Distribution; China; Disease Progression; Euthyroid Sick Syndromes - diagnosis; Euthyroid Sick Syndromes - drug therapy; Euthyroid Sick Syndromes - etiology; Female; Glomerular Filtration Rate - drug effects; Humans; Kaplan-Meier Estimate; Kidney - drug effects; Kidney - physiopathology; Kidney Failure, Chronic - etiology; Kidney Failure, Chronic - physiopathology; Kidney Failure, Chronic - prevention & control; Male; Medicine; Medicine & Public Health; Middle Aged; Nephrology; Original Article; Proportional Hazards Models; Renal Insufficiency, Chronic - complications; Renal Insufficiency, Chronic - diagnosis; Renal Insufficiency, Chronic - drug therapy; Renal Insufficiency, Chronic - physiopathology; Risk Factors; Single-Blind Method; Sodium Bicarbonate - adverse effects; Sodium Bicarbonate - therapeutic use; Time Factors; Treatment Outcome; Urology
• ISSN: 1121-8428; 1724-6059
• DOI: 10.1007/s40620-016-0341-2

Aim Non-thyroidal illness syndrome (NTIS) is common among patients with advanced chronic kidney disease (CKD) and is strongly associated with poor prognosis. However, it remains unclear in how to correct this disorder and this study aimed to evaluate the effectiveness of sodium bicarbonate (SB) and N-acetyl-cysteine (NAC) for correcting NTIS status. Methods Patients with CKD stage 3–4 were single-blind, placebo-controlled treated with placebo, SB, or NAC for 18 weeks. The primary end points were the correction of NTIS and the occurrence of end-stage renal disease (ESRD). The secondary point was the change in estimated glomerular filtration rate (eGFR) after the follow-up. Results The Kaplan–Meier survival analysis showed significant lower correcting ratio of NTIS in control group compared with SB group [Hazard ratio (HR) 0.19, 95 % confidence interval (CI) 0.04–0.89, p = 0.035] and NAC group (HR 0.09, 95 % CI 0.02–0.38, p = 0.001), and increased ESRD risk in control group than in SB group (HR 1.97, 95 % CI 1.02–3.84, p = 0.045) and NAC group (HR 5.50, 95 % CI 2.23–13.57, p