Prevalence and incidence of hypothyroidism and hyperthyroidism in patients with chronic kidney disease on dialysis: a systematic review and meta-analysis

BACKGROUND AND HYPOTHESIS: Chronic kidney disease (CKD) affects thyroid metabolism, increasing the risk of hypothyroidism and hyperthyroidism. Dialysis further alters hormone levels through impaired synthesis, iodine imbalance, and treatment-related factors. This study aimed to evaluate the prevalence and incidence of hypothyroidism and hyperthyroidism in patients with CKD on dialysis. METHODS: We conducted a search in the Scopus and PubMed databases up to November 29, 2024. We included studies reporting prevalence or incidence data on hypothyroidism or hyperthyroidism (clinical or subclinical) in CKD patients on dialysis (hemodialysis or peritoneal dialysis). A random-effects model meta-analysis of proportions was used to calculate pooled prevalence estimates. RESULTS: A total of 39 studies were included, with sample sizes ranging from 40 to 8840 participants. The prevalence of hypothyroidism was 15.9% (95% CI: 13.0 to 19.0; I²: 96.2%), with 5.6% for clinical hypothyroidism and 11.2% for subclinical hypothyroidism (notably higher in peritoneal dialysis). The prevalence of hyperthyroidism was 5.1% (95% CI: 2.7 to 8.2; I²: 93.8%), with 0.9% for clinical hyperthyroidism and 3.3% for subclinical hyperthyroidism. Meta-regression analyses indicated that a longer mean duration on dialysis was associated with a lower prevalence of hypothyroidism (p = 0.008). Only one study reported the incidence of hypothyroidism (10.9%) and hyperthyroidism (4.9%), thus evidence on incidence remains scarce. CONCLUSION: The prevalence of hypothyroidism and hyperthyroidism in patients with CKD on dialysis is high, although with high heterogeneity among studies. Evidence on incidence remains limited and should be interpreted as exploratory. These findings support increased clinical vigilance and consideration of early detection strategies rather than definitive screening policies.