title: Prevalence and clinical implications of testosterone deficiency in men with end-stage renal disease.
abstract: BACKGROUND
  Abnormally low serum testosterone levels were recently associated with an increased mortality risk in male dialysis patients. However, the prevalence of testosterone deficiency in end-stage renal disease (ESRD) is not well defined. We hereby explore the prevalence and correlates of clinical testosterone deficiency in a large cohort of ESRD male patients.
  
  
  METHODS
  Two hundred and sixty ESRD men [median age 59 (25th-75th percentile 48-67)  years] were included. Testosterone concentration and testosterone deficiency (<10 nmol/L) were studied in relation to clinically evident cardiovascular disease and markers of inflammation at baseline as well as deaths registered during the following 36 months.
  
  
  RESULTS
  Testosterone deficiency was present in 44% of the patients, while 33% showed testosterone insufficiency (10-14 nmol/L), and only 23% had normal testosterone values (>14 nmol/L). Testosterone was strongly and inversely correlated to inflammatory markers (CRP, IL-6 and fibrinogen), even after correction for age and sex hormone-binding globulin. In a crude spline curve, low testosterone concentrations were associated with worse outcome. A clinical condition of testosterone deficiency was independently associated with cardiovascular co-morbidity [odds ratio (OR) 2.51; 95% confidence interval (CI) 1.32-4.76] and death (OR 2.00; 95% CI 1.01-3.97) in logistic regression analyses.
  
  
  CONCLUSIONS
  Testosterone deficiency is a common finding among male ESRD patients, and it is independently associated with inflammation, cardiovascular co-morbidity and outcome. Future studies are needed to determine the potential adverse effects of male hypogonadism in ESRD and the possibility of improving risk profile, quality of life, and ultimately outcome with testosterone supplementation in these patients.
authors.affiliation: Division of Renal Medicine, Karolinska Institutet, Stockholm, Sweden. juan.jesus.carrero@ki.se
authors.forename: Juan Jesús
authors.initials: JJ
authors.lastname: Carrero
authors.forename: Abdul Rashid
authors.initials: AR
authors.lastname: Qureshi
authors.forename: Ayumu
authors.initials: A
authors.lastname: Nakashima
authors.forename: Stefan
authors.initials: S
authors.lastname: Arver
authors.forename: Paolo
authors.initials: P
authors.lastname: Parini
authors.forename: Bengt
authors.initials: B
authors.lastname: Lindholm
authors.forename: Peter
authors.initials: P
authors.lastname: Bárány
authors.forename: Olof
authors.initials: O
authors.lastname: Heimbürger
authors.forename: Peter
authors.initials: P
authors.lastname: Stenvinkel
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000097:blood; D015331:Cohort Studies; D015897:Comorbidity; D006801:Humans; D007249:Inflammation / Q000097:blood; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D006435:Renal Dialysis; D013739:Testosterone / Q000097:blood / Q000172:deficiency*
chemical_list: D013739:Testosterone