Low Serum Testosterone Increases Mortality Risk among Male Dialysis Patients

作者：Juan Jesús Carrero, Abdul Rashid Qureshi, Paolo Parini, Stefan Arver, Bengt Lindholm, Peter BaCombining Acute AccentraCombining Acute Accentny, Olof Heimbu[Combining Diaeresis]rger, Peter Stenvinkel · 发表于：Journal of the American Society of Nephrology · 年份：2009 · DOI：10.1681/asn.2008060664 · 被引用次数：189 · 研究领域：Hormonal and reproductive studies、Sexual function and dysfunction studies、Doping in Sports

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.