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

J Nephrol. 2017 Aug;30(4):557-565. doi: 10.1007/s40620-016-0341-2. Epub 2016 Aug 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 < 0.001). The Cox regression analysis demonstrated significantly different effectiveness of placebo, SB and NAC on NTIS correction and ESRD risk, p < 0.05, respectively. Variance analysis displayed a greater reduction in eGFR in controls than in SB (p = 0.044) and NAC group (p < 0.001).

Conclusion: SB and NAC are effective in promoting the recovery from NTIS status and delaying the deterioration of renal function in advanced CKD patients.

Keywords: Chronic kidney disease; N-acetyl-cysteine; Non-thyroidal illness syndrome; Sodium bicarbonate.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • 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
  • Middle Aged
  • 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


  • Sodium Bicarbonate
  • Acetylcysteine