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Testosterone Deficiency and Nutritional Parameters as Predictors of All-Cause Mortality among Male Dialysis Patients. Nutrients 2022; 14:nu14214461. [PMID: 36364724 PMCID: PMC9656627 DOI: 10.3390/nu14214461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Chronic kidney disease (CKD) is associated with an accelerated risk of cardiovascular mortality. Hormonal and metabolic disorders in CKD may constitute novel risk factors. Our objective was to characterize and evaluate prognostic implications of circulating sex steroids and selected nutritional parameters in patients at different stages of CKD. Methods: Studied groups were composed of 78 men: 31 on hemodialysis (HD), 17 on peritoneal dialysis (PD), 30 with CKD stage G3-G4. Total testosterone (TT), dehydroepiandrosterone sulphate (DHEA-S), androstenedione, luteinizing hormone (LH), prolactin (PRL), and biochemical parameters were measured; Free testosterone (FT) was calculated. Results: The lowest TT and FT were observed in HD, the highest- in CKD (p = 0.006 for TT, p = 0.005 for FT). TT positively correlated with total cholesterol in HD (p = 0.012), FT negatively correlated with BMI in CKD (p = 0.023). During the 12 months, 9 patients died (5 in the HD, 4 in the PD group). The deceased group had significantly lower concentrations of albumin (p = 0.006) and prealbumin (p = 0.001), and a significantly higher concentration of androstenedione (p = 0.019) than the surviving group. In the group of men on dialysis, a serum TT concentration <2.55 ng/mL (Q1-first quartile) was associated with a 3.7-fold higher risk of death, although statistical significance was not achieved (p = 0.198). After analysis of the ROC curves, the FT level was the best prognostic marker in HD (AUC = 0.788; 95% CI: 0.581−0.996; p = 0.006) Conclusions: Total and free testosterone levels were lower in the HD group than in the CKD group. The nutritional status undoubtedly affects the survival of dialysis patients but also the concentrations of testosterone significantly contributes to further worsening the prognosis.
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Hecking M, Hödlmoser S, Ahmed SB, Carrero JJ. The Other Way Around: Living With Chronic Kidney Disease From the Perspective of Men. Semin Nephrol 2022; 42:122-128. [PMID: 35718360 DOI: 10.1016/j.semnephrol.2022.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A wealth of evidence has suggested sex (biological) and gender (sociocultural) differences in the prevalence, progression, and outcomes of persons with chronic kidney disease. Much of this evidence tends to emphasize differences in which women are disadvantaged, and less attention is paid to findings in which women are better off or similar to men. However, gender medicine recognizes that men and women have different disease determinants, presentation, and attitudes, and it pertains to both sexes. In this review, we revisit chronic kidney disease through the perspective of men, and illustrate a population segment at need of stringent preventative and management strategies.
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Affiliation(s)
- Manfred Hecking
- Department of Internal Medicine III, Clinical Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
| | - Sebastian Hödlmoser
- Department of Internal Medicine III, Clinical Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
| | - Sofia B Ahmed
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Juan Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Centre for Gender Medicine, Karolinska Institutet, Stockholm, Sweden.
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Yu J, Ravel VA, You AS, Streja E, Rivara MB, Potukuchi PK, Brunelli SM, Kovesdy CP, Kalantar-Zadeh K, Rhee CM. Association between Testosterone and Mortality Risk among U.S. Males Receiving Dialysis. Am J Nephrol 2017; 46:195-203. [PMID: 28858868 DOI: 10.1159/000480302] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 08/08/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Among the general population, low circulating testosterone levels are associated with higher risk of cardiovascular disease and death. While testosterone deficiency is common in dialysis patients, studies of testosterone and mortality in this population are ambiguous and overlapping. We hypothesized that lower testosterone levels are associated with higher mortality in male dialysis patients. METHODS We examined a nationally representative cohort of male dialysis patients from a large US dialysis organization who underwent one or more total testosterone measurements from 1/2007 to 12/2011. The association between total testosterone categorized as quartiles and all-cause mortality was studied using Cox models adjusted for expanded case-mix and laboratory covariates. We also examined total testosterone as a continuous predictor of all-cause mortality using restricted cubic splines. RESULTS Among 624 male dialysis patients, 51% of patients demonstrated testosterone deficiency (total testosterone <300 ng/dL); median (IQR) total testosterone levels were 297 (190-424) ng/mL. In expanded case-mix + laboratory adjusted Cox analyses, we observed a graded association between lower testosterone levels and higher mortality risk (ref: quartile 3): adjusted hazard ratios (95% CI) 2.32 (1.33-4.06), 1.80 (0.99-3.28), and 0.68 (0.32-1.42) for Quartiles 1, 2, and 4, respectively. In adjusted spline analyses, the lower testosterone-higher mortality risk association declined with higher testosterone levels until the value reached a threshold of 400 ng/dL above which risk plateaued. CONCLUSION Lower testosterone levels were independently associated with higher mortality risk in male dialysis patients. Further studies are needed to determine underlying mechanisms, and whether testosterone replacement ameliorates death risk in this population.
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Affiliation(s)
- Jerry Yu
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, CA, USA
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Sex and gender differences in chronic kidney disease: progression to end-stage renal disease and haemodialysis. Clin Sci (Lond) 2017; 130:1147-63. [PMID: 27252402 DOI: 10.1042/cs20160047] [Citation(s) in RCA: 149] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 03/29/2016] [Indexed: 01/04/2023]
Abstract
Sex and gender differences are of fundamental importance in most diseases, including chronic kidney disease (CKD). Men and women with CKD differ with regard to the underlying pathophysiology of the disease and its complications, present different symptoms and signs, respond differently to therapy and tolerate/cope with the disease differently. Yet an approach using gender in the prevention and treatment of CKD, implementation of clinical practice guidelines and in research has been largely neglected. The present review highlights some sex- and gender-specific evidence in the field of CKD, starting with a critical appraisal of the lack of inclusion of women in randomized clinical trials in nephrology, and thereafter revisits sex/gender differences in kidney pathophysiology, kidney disease progression, outcomes and management of haemodialysis care. In each case we critically consider whether apparent discrepancies are likely to be explained by biological or psycho-socioeconomic factors. In some cases (a few), these findings have resulted in the discovery of disease pathways and/or therapeutic opportunities for improvement. In most cases, they have been reported as merely anecdotal findings. The aim of the present review is to expose some of the stimulating hypotheses arising from these observations as a preamble for stricter approaches using gender for the prevention and treatment of CKD and its complications.
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Hekimoglu A, Tatar IG, Ergun O, Turan A, Aylı MD, Hekimoglu B. Shear Wave Sonoelastography Findings of Testicles in Chronic Kidney Disease Patients Who Undergo Hemodialysis. Eurasian J Med 2017; 49:12-15. [PMID: 28416925 DOI: 10.5152/eurasianjmed.2017.16173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Chronic kidney disease (CKD) is known to cause significant deterioration in the function of the testicles and sexual dysfunction in male patients who undergo hemodialysis. The aim of this study was to show the changes in the testicles that occur as a result of hypogonadism secondary to CKD and to analyze the elasticity of the parenchyma by shear wave sonoelastography. MATERIALS AND METHODS In our study we included 28 male patients who undergo dialysis three times per week and 25 healthy volunteers. Firstly, B-mode ultrasonographic evaluation was performed in both testicles for structural analysis and to detect the presence of focal lesions. Afterward, the stiffness of the parenchyma was measured in kilopascals by shear wave sonoelastography. RESULTS The CKD group had lower right, left, and mean testicular volumes (p<0.001). The CKD group also displayed greater right, left, and mean testicular parenchymal stiffness (p<0.001). CONCLUSION CKD patients who undergo hemodialysis demonstrated significant changes in testicular size and stiffness in comparison to healthy volunteers.
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Affiliation(s)
- Azad Hekimoglu
- Department of Radiology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Idil Gunes Tatar
- Department of Radiology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Onur Ergun
- Department of Radiology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Aynur Turan
- Department of Radiology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Mehmet Deniz Aylı
- Department of Nephrology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Baki Hekimoglu
- Department of Radiology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
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Cobo G, Gallar P, Di Gioia C, García Lacalle C, Camacho R, Rodriguez I, Ortega O, Mon C, Vigil A, Lindholm B, Carrero JJ. Hypogonadism associated with muscle atrophy, physical inactivity and ESA hyporesponsiveness in men undergoing haemodialysis. Nefrologia 2016; 37:54-60. [PMID: 27553987 DOI: 10.1016/j.nefro.2016.04.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 03/31/2016] [Accepted: 04/28/2016] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Testosterone deficiency (hypogonadism) is common among men undergoing haemodialysis, but its clinical implications are not well characterized. Testosterone is an anabolic hormone that induces erythrocytosis and muscle synthesis. We hypothesized that testosterone deficiency would be associated with low muscle mass, physical inactivity and higher dosages of erythropoietin-stimulating agents (ESA). METHODS Single-center cross-sectional study of 57 male haemodialysis patients. None of the patients was undergoing testosterone replacement therapy. Total testosterone was measured in serum. Body composition (by bioelectrical impedance analysis) and physical activity (by the use of pedometers) were assessed. Patients with testosterone levels below the normal range were considered hypogonadal. RESULTS Mean testosterone level was 321±146ng/dL; 20 patients (35%) were hypogonadal. Hypogonadal patients were older and had lower mean arterial blood pressure, higher interleukin-6 levels, lower lean body mass and higher fat body mass. A negative association between testosterone and normalized ESA dose was found in uni- and multivariate regression analyses. Testosterone levels directly correlated with lean body mass regardless of confounders. Hypogonadal patients had lower physical activity than their counterparts [2753±1784 vs. 4291±3225steps/day (p=0.04)]. The relationship between testosterone and physical activity was independent of age, comorbidities and inflammatory markers, but dependent on the proportion of muscle mass. CONCLUSION Hypogonadism is common in our male haemodialysis population and is associated with higher ESA doses, reduced muscle mass and lower physical activity. The link between low testosterone levels and physical inactivity may conceivably relate to reduced muscle mass due to inadequate muscle protein synthesis.
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Affiliation(s)
- Gabriela Cobo
- Department of Nephrology, Hospital Severo Ochoa, Leganes, Madrid, Spain; Divisions of Renal Medicine and Baxter Novum, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
| | - Paloma Gallar
- Department of Nephrology, Hospital Severo Ochoa, Leganes, Madrid, Spain
| | - Cristina Di Gioia
- Department of Nephrology, Hospital Severo Ochoa, Leganes, Madrid, Spain
| | | | - Rosa Camacho
- Department of Nephrology, Hospital Severo Ochoa, Leganes, Madrid, Spain
| | - Isabel Rodriguez
- Department of Nephrology, Hospital Severo Ochoa, Leganes, Madrid, Spain
| | - Olimpia Ortega
- Department of Nephrology, Hospital Severo Ochoa, Leganes, Madrid, Spain
| | - Carmen Mon
- Department of Nephrology, Hospital Severo Ochoa, Leganes, Madrid, Spain
| | - Ana Vigil
- Department of Nephrology, Hospital Severo Ochoa, Leganes, Madrid, Spain
| | - Bengt Lindholm
- Divisions of Renal Medicine and Baxter Novum, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Juan Jesús Carrero
- Divisions of Renal Medicine and Baxter Novum, CLINTEC, Karolinska Institutet, Stockholm, Sweden
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Dhindsa S, Reddy A, Karam JS, Bilkis S, Chaurasia A, Mehta A, Raja KP, Batra M, Dandona P. Prevalence of subnormal testosterone concentrations in men with type 2 diabetes and chronic kidney disease. Eur J Endocrinol 2015; 173:359-66. [PMID: 26101371 DOI: 10.1530/eje-15-0359] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 06/22/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND One-third of men with type 2 diabetes have subnormal testosterone concentrations along with inappropriately normal LH and FSH concentrations. It is not known if the presence of renal insufficiency affects free testosterone concentrations in men with type 2 diabetes. HYPOTHESIS We hypothesized that type 2 diabetic men with chronic renal disease (CKD; estimated glomerular filtration rate (eGFR) < 60 ml/min per 1.73 m(2)) have lower free testosterone concentrations than men with normal renal function (eGFR ≥ 60 ml/min per 1.73 m(2)). STUDY DESIGN AND SETTING This is a retrospective chart review of patients attending diabetes and nephrology clinics. Men with type 2 diabetes who had the following information available were included in the study: testosterone (total and free) done by LC/MS-MS followed by equilibrium dialysis, sex hormone binding globulin, LH, FSH and prolactin concentrations. PARTICIPANTS We present data on T and gonadotropin concentrations in 111 men with type 2 diabetes and CKD (stages 3-5) and 182 type 2 diabetic men without CKD. RESULTS The prevalence of subnormal free testosterone concentrations was higher in men with type 2 diabetes and CKD as compared to those without CKD (66% vs 37%, P < 0.001). Men with CKD had a higher prevalence of hypergonadotropic hypogonadism (26% vs 5%, P < 0.001) but not of hypogonadotropic hypogonadism (HH; 40% vs 32%, P = 0.22). There was an increase in the prevalence of hypergonadotropic hypogonadism with decreasing eGFR. Fifty-two percent of men with renal failure (CKD stage 5) had hypergonadotropic hypogonadism and 25% had HH. In men with CKD, the hemoglobin concentrations were lower in those with subnormal free T concentrations as compared to men with normal free T concentrations (119 ± 19 vs 128 ± 19 g/l, P = 0.04). CONCLUSIONS Two-thirds of men with type 2 diabetes and CKD have subnormal free T concentrations. The hypogonadism associated with CKD is predominantly hypergonadotropic.
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Affiliation(s)
- Sandeep Dhindsa
- Department of MedicineDivision of Endocrinology and Metabolism, Texas Tech University Health Sciences Center, Permian Basin Campus, 701 W 5th Street, Odessa, 79763 Texas, USAPermian Basin Kidney CenterOdessa, Texas, USANephrology AssociatesMurfreesboro, Tennessee, USADepartment of MedicineDivision of Endocrinology and Metabolism and the Diabetes and Endocrinology Center of Western New York, State University of New York at Buffalo, Buffalo, New York, USA
| | - Anand Reddy
- Department of MedicineDivision of Endocrinology and Metabolism, Texas Tech University Health Sciences Center, Permian Basin Campus, 701 W 5th Street, Odessa, 79763 Texas, USAPermian Basin Kidney CenterOdessa, Texas, USANephrology AssociatesMurfreesboro, Tennessee, USADepartment of MedicineDivision of Endocrinology and Metabolism and the Diabetes and Endocrinology Center of Western New York, State University of New York at Buffalo, Buffalo, New York, USA Department of MedicineDivision of Endocrinology and Metabolism, Texas Tech University Health Sciences Center, Permian Basin Campus, 701 W 5th Street, Odessa, 79763 Texas, USAPermian Basin Kidney CenterOdessa, Texas, USANephrology AssociatesMurfreesboro, Tennessee, USADepartment of MedicineDivision of Endocrinology and Metabolism and the Diabetes and Endocrinology Center of Western New York, State University of New York at Buffalo, Buffalo, New York, USA
| | - Jyotheen Sukhmoy Karam
- Department of MedicineDivision of Endocrinology and Metabolism, Texas Tech University Health Sciences Center, Permian Basin Campus, 701 W 5th Street, Odessa, 79763 Texas, USAPermian Basin Kidney CenterOdessa, Texas, USANephrology AssociatesMurfreesboro, Tennessee, USADepartment of MedicineDivision of Endocrinology and Metabolism and the Diabetes and Endocrinology Center of Western New York, State University of New York at Buffalo, Buffalo, New York, USA
| | - Sayeeda Bilkis
- Department of MedicineDivision of Endocrinology and Metabolism, Texas Tech University Health Sciences Center, Permian Basin Campus, 701 W 5th Street, Odessa, 79763 Texas, USAPermian Basin Kidney CenterOdessa, Texas, USANephrology AssociatesMurfreesboro, Tennessee, USADepartment of MedicineDivision of Endocrinology and Metabolism and the Diabetes and Endocrinology Center of Western New York, State University of New York at Buffalo, Buffalo, New York, USA
| | - Archana Chaurasia
- Department of MedicineDivision of Endocrinology and Metabolism, Texas Tech University Health Sciences Center, Permian Basin Campus, 701 W 5th Street, Odessa, 79763 Texas, USAPermian Basin Kidney CenterOdessa, Texas, USANephrology AssociatesMurfreesboro, Tennessee, USADepartment of MedicineDivision of Endocrinology and Metabolism and the Diabetes and Endocrinology Center of Western New York, State University of New York at Buffalo, Buffalo, New York, USA
| | - Aditya Mehta
- Department of MedicineDivision of Endocrinology and Metabolism, Texas Tech University Health Sciences Center, Permian Basin Campus, 701 W 5th Street, Odessa, 79763 Texas, USAPermian Basin Kidney CenterOdessa, Texas, USANephrology AssociatesMurfreesboro, Tennessee, USADepartment of MedicineDivision of Endocrinology and Metabolism and the Diabetes and Endocrinology Center of Western New York, State University of New York at Buffalo, Buffalo, New York, USA
| | - Keerthi P Raja
- Department of MedicineDivision of Endocrinology and Metabolism, Texas Tech University Health Sciences Center, Permian Basin Campus, 701 W 5th Street, Odessa, 79763 Texas, USAPermian Basin Kidney CenterOdessa, Texas, USANephrology AssociatesMurfreesboro, Tennessee, USADepartment of MedicineDivision of Endocrinology and Metabolism and the Diabetes and Endocrinology Center of Western New York, State University of New York at Buffalo, Buffalo, New York, USA
| | - Manav Batra
- Department of MedicineDivision of Endocrinology and Metabolism, Texas Tech University Health Sciences Center, Permian Basin Campus, 701 W 5th Street, Odessa, 79763 Texas, USAPermian Basin Kidney CenterOdessa, Texas, USANephrology AssociatesMurfreesboro, Tennessee, USADepartment of MedicineDivision of Endocrinology and Metabolism and the Diabetes and Endocrinology Center of Western New York, State University of New York at Buffalo, Buffalo, New York, USA
| | - Paresh Dandona
- Department of MedicineDivision of Endocrinology and Metabolism, Texas Tech University Health Sciences Center, Permian Basin Campus, 701 W 5th Street, Odessa, 79763 Texas, USAPermian Basin Kidney CenterOdessa, Texas, USANephrology AssociatesMurfreesboro, Tennessee, USADepartment of MedicineDivision of Endocrinology and Metabolism and the Diabetes and Endocrinology Center of Western New York, State University of New York at Buffalo, Buffalo, New York, USA
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