title: Decreased serum adrenal androgen dehydroepiandrosterone sulfate and mortality in hemodialysis patients.
abstract: BACKGROUND
  Endocrine and metabolic abnormalities may affect the survival of hemodialysis patients. Serum dehydroepiandrosterone sulfate (DHEA-S), an adrenal androgen with anabolic properties, is known to be lowered in ill patients and predicts poor outcome in the general population and in those with cardiac disease. The aims of this study were to examine a possible change in the DHEA-S level in dialysis patients and its association with survival in this population.
  
  
  METHODS
  This was an observational cohort study in 494 prevalent hemodialysis patients (313 men and 181 women) in urban area of Osaka, Japan. The main exposure was the baseline DHEA-S level in December 2004 and the key outcome was all-cause mortality during the subsequent 5 years. Also, DHEA-S levels were compared between the hemodialysis patients and 122 matched healthy controls.
  
  
  RESULTS
  The median (inter-quartile range) DHEA-S levels were 771 (447-1351) and 414 (280-659) ng/mL for male and female dialysis patients, respectively, and these values were significantly lower by 40-53% than the healthy control levels. Among the hemodialysis patients, DHEA-S was lower in women, those with older age, pre-existing cardiovascular disease, lower serum albumin and higher C-reactive protein. During the follow-up, we recorded 101 deaths. A low DHEA-S level was a significant predictor of all-cause mortality independent of potential confounders in male, but not in female, hemodialysis patients.
  
  
  CONCLUSIONS
  The serum DHEA-S level is decreased in hemodialysis patients and associated with mortality in men. These results support the growing observational evidence that uremia-induced endocrine alterations including decreased sex hormones may be linked to adverse clinical outcomes.
authors: Department of Metabolism, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors: Ryusuke
authors: R
authors: Kakiya
authors: Tetsuo
authors: T
authors: Shoji
authors: Tomoshige
authors: T
authors: Hayashi
authors: Naoko
authors: N
authors: Tatsumi-Shimomura
authors: Yoshihiro
authors: Y
authors: Tsujimoto
authors: Tsutomu
authors: T
authors: Tabata
authors: Hideaki
authors: H
authors: Shima
authors: Katsuhito
authors: K
authors: Mori
authors: Shinya
authors: S
authors: Fukumoto
authors: Hideki
authors: H
authors: Tahara
authors: Hidenori
authors: H
authors: Koyama
authors: Masanori
authors: M
authors: Emoto
authors: Eiji
authors: E
authors: Ishimura
authors: Yoshiki
authors: Y
authors: Nishizawa
authors: Masaaki
authors: M
authors: Inaba
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology / Q000401:mortality; D016022:Case-Control Studies; D015331:Cohort Studies; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood*; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011502:Protein-Energy Malnutrition / Q000097:blood / Q000209:etiology; D006435:Renal Dialysis / Q000401:mortality*
chemical_list: D019314:Dehydroepiandrosterone Sulfate