Endogenous testosterone and mortality in male hemodialysis patients: is it the result of aging?
OBJECTIVE
Low serum testosterone levels in hemodialysis (HD) patients have recently been associated with cardiovascular risk factors and increased mortality. To confirm this observation, we investigated the predictive role of serum total testosterone levels on mortality in a large group of male HD patients from Turkey.


METHODS
A total of 420 prevalent male HD patients were sampled in March 2005 and followed up for all-cause mortality. Serum total testosterone levels were measured by ELISA at baseline and studied in relation to mortality and cardiovascular risk profile.


RESULTS
Mean testosterone level was 8.69 ± 4.10 (0.17 to 27.40) nmol/L. A large proportion of patients (66%) had testosterone deficiency (<10 nmol/L). In univariate analysis, serum testosterone levels were positively correlated with creatinine and inversely correlated with age, body mass index, and lipid parameters. During an average follow-up of 32 months, 104 (24.8%) patients died. The overall survival rate was significantly lower in patients within the low testosterone tertile (<6.8 nmol/L) compared with those within the high tertile (>10.1 nmol/L; 64 versus 81%; P = 0.004). A 1-nmol/L increase in serum testosterone level was associated with a 7% decrease in overall mortality (hazard ratio 0.93; 95% confidence interval 0.89 to 0.98; P = 0.01); however, this association was dependent on age and other risk factors in adjusted Cox regression analyses.


CONCLUSIONS
Testosterone deficiency is common in male HD patients. Although testosterone levels, per se, predicted mortality in this population, this association was largely dependent on age.
Gungor
Ozkan
O
Ege University School of Medicine, Division of Nephrology, Izmir, Turkey. ozkan.gungor@yahoo.com
Kircelli
Fatih
F
Carrero
Juan Jesus
JJ
Asci
Gulay
G
Toz
Huseyin
H
Tatar
Erhan
E
Hur
Ender
E
Sever
Mehmet Sukru
MS
Arinsoy
Turgay
T
Ok
Ercan
E
D000328:Adult; D000367:Age Factors; D000368:Aged; D000375:Aging / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology* / Q000401:mortality; D003430:Cross-Sectional Studies; D004797:Enzyme-Linked Immunosorbent Assay; D006801:Humans; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000097:blood / Q000150:complications / Q000401:mortality / Q000628:therapy*; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000401:mortality*; D018570:Risk Assessment; D012307:Risk Factors; D013739:Testosterone / Q000097:blood / Q000172:deficiency*; D013997:Time Factors; D016896:Treatment Outcome; D014421:Turkey / Q000453:epidemiology
D015415:Biomarkers; D013739:Testosterone