Ontology highlight
ABSTRACT: Background
Hypogonadism in men (total testosterone <350 ng/dL) is associated with higher risk of cardiovascular disease and mortality in men on dialysis therapy. We evaluated the association of hypogonadism with all-cause mortality in men with non-dialysis-dependent chronic kidney disease (CKD).Study design
Retrospective, cohort study.Setting & participants
2,419 men with CKD stages 3-4 (estimated glomerular filtration rate, 15-59 mL/min/1.73 m2) who had total testosterone measured for cause between January 1, 2005, and October 31, 2011, at a tertiary-care center in Cleveland, OH.Predictors
Total testosterone measured using an immunoassay measurement in 3 forms: (1) categorized as low or testosterone replacement therapy versus normal, (2) continuous log testosterone, and (3) quintiles (100-226, 227-305, 306-392, 393-511, and 512-3,153 ng/dL).Outcomes
Factors associated with low total testosterone level and the association between low total testosterone level and all-cause mortality were evaluated using logistic regression, Cox proportional hazard models, and Kaplan-Meier survival curves.Results
Hypogonadism was found in 1,288 of 2,419 (53%) men. In a multivariable logistic regression analysis, African American ethnicity and higher estimated glomerular filtration rate were associated with lower odds of having hypogonadism. Diabetes and higher body mass index were associated with higher odds of having hypogonadism. 357 of 2,419 (15%) patients died during a median follow-up of 2.3 years. In the multivariate Cox model, testosterone level <350 ng/dL or testosterone replacement therapy was not associated with mortality. In a multivariable model also adjusted for testosterone supplementation, higher log testosterone was associated with significantly lower mortality (HR per 1 log unit, 0.70; 95% CI, 0.55-0.89). When compared to the highest quintile, the second lowest quintile of testosterone was associated with higher mortality (HR, 1.53; 95% CI, 1.09-2.16).Limitations
Single-center study, timing of testosterone testing, lack of adjustment for proteinuria, and sampling bias.Conclusions
Low total testosterone level may be associated with higher mortality in men with CKD stages 3-4, but more studies are needed.
SUBMITTER: Khurana KK
PROVIDER: S-EPMC4143431 | biostudies-literature | 2014 Sep
REPOSITORIES: biostudies-literature
Khurana Kiranpreet K KK Navaneethan Sankar D SD Arrigain Susana S Schold Jesse D JD Nally Joseph V JV Shoskes Daniel A DA
American journal of kidney diseases : the official journal of the National Kidney Foundation 20140413 3
<h4>Background</h4>Hypogonadism in men (total testosterone <350 ng/dL) is associated with higher risk of cardiovascular disease and mortality in men on dialysis therapy. We evaluated the association of hypogonadism with all-cause mortality in men with non-dialysis-dependent chronic kidney disease (CKD).<h4>Study design</h4>Retrospective, cohort study.<h4>Setting & participants</h4>2,419 men with CKD stages 3-4 (estimated glomerular filtration rate, 15-59 mL/min/1.73 m2) who had total testosteron ...[more]