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Low Serum Testosterone Increases Mortality Risk among Male Dialysis Patients

Juan Jesús Carrero^*, Abdul Rashid Qureshi^*, Paolo Parini, Stefan Arver, Bengt Lindholm^*, Peter Bárány^*, Olof Heimbürger^* and Peter Stenvinkel^*

^* Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Division of Clinical Chemistry, Department of Laboratory Medicine and Center for Andrology and Sexual Medicine, Karolinska Institutet, Stockholm, Sweden

Correspondence: Dr. Peter Stenvinkel, Department of Renal Medicine K56, Karolinska University Hospital at Huddinge, 141 86 Stockholm, Sweden. Phone: +46-8-58582532; Fax: +46-8-711472; E-mail: peter.stenvinkel{at}ki.se; and Dr. Juan Jesús Carrero, Department of Renal Medicine K56,Karolinska University Hospital at Huddinge, 141 86 Stockholm, Sweden. Phone: +46-8-58583982; Fax: +46-8-58583925; E-mail: juan.jesus.carrero{at}ki.se

Received for publication June 30, 2008. Accepted for publication September 18, 2008.

Men treated with hemodialysis (HD) have a very poor prognosis and an elevated risk of premature cardiovascular disease (CVD). In the general population, associations between low testosterone concentrations and cardiovascular risk have been suggested. We performed a prospective observational study involving a well characterized cohort of 126 men treated with HD to examine the relationship between testosterone concentration and subsequent mortality during a mean follow-up period of 41 mo. Independent of age, serum creatinine, and sexual hormone binding globulin (SHBG), testosterone levels inversely and strongly associated with the inflammatory markers IL-6 and CRP. Patients with a clinical history of CVD had significantly lower testosterone levels. During follow up, 65 deaths occurred, 58% of which were a result of CVD. Men with testosterone values in the lowest tertile had increased all-cause and CVD mortality (crude hazard ratios [HRs] 2.03 [95% CI 1.24 to 3.31] and 3.19 [1.49 to 6.83], respectively), which persisted after adjustment for age, SHBG, previous CVD, diabetes, ACEi/ARB treatment, albumin, and inflammatory markers, but was lost after adjustment for creatinine. In summary, among men treated with HD, testosterone concentrations inversely correlate with all-cause and CVD-related mortality, as well as with markers of inflammation. Hypogonadism may be an additional treatable risk factor for patients with chronic kidney disease.

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Copyright © 2009 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673