Renin-angiotensin blockade reduces serum free testosterone in middle-aged men on haemodialysis and correlates with erythropoietin resistance.
BACKGROUND
There are conflicting reports about the importance of the renin-angiotensin system (RAS) on erythropoietin (Epo) sensitivity in haemodialysis patients, but the role of gender has not been studied specifically. The hypothesis underlying this study is that Epo resistance associated with RAS blockade (RASB) is specific to men and related to drug-induced lowering of circulating testosterone.


METHODS
Men and women undergoing chronic haemodialysis were divided into groups according to whether or not they were receiving RASB. Serum was collected pre-dialysis for determination of free testosterone levels by enzyme immunoassay. Routine laboratory data and Epo doses were collated and analysed for the 3 month period prior to the measurement of the hormone level.


RESULTS
Control women required more Epo than control men (P=0.002), but the Epo doses between men and women with RASB were similar. Men with RASB required more Epo than control men (P=0.002), but RASB had no effect on Epo requirements in women. There was a significant relationship between age and testosterone levels in control men (P=0.01) that was not present in men taking RASB. RASB was associated with lower levels of serum testosterone in men <60 years old (P=0.02), but had no effect on serum testosterone levels in older men or women. Multiple regression analysis demonstrated that serum testosterone negatively correlated with Epo dose (P=0.045) when all groups of patients were considered together.


CONCLUSIONS
These data suggest that androgens may participate in Epo resistance associated with RASB in patients on haemodialysis, and that the effect is related to both gender and age.
DeLong
Michael
M
Department of Medicine, Renal Section, PO Box 245022, Arizona Health Sciences Center, University of Arizona, 1501 N. Campbell Ave., Tucson, AZ 85724, USA.
Logan
Joy L
JL
Yong
Kim-Chong
KC
Lien
Yeong-Hau H
YH
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D047228:Angiotensin II Type 1 Receptor Blockers / Q000494:pharmacology*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology*; D016022:Case-Control Studies; D004351:Drug Resistance / Q000187:drug effects*; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000494:pharmacology*; D005260:Female; D006397:Hematinics / Q000494:pharmacology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins; D006435:Renal Dialysis; D012737:Sex Factors; D013739:Testosterone / Q000097:blood* / Q000172:deficiency
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D006397:Hematinics; D011994:Recombinant Proteins; D004921:Erythropoietin; D013739:Testosterone; D000068817:Epoetin Alfa