title: Serum testosterone levels and mortality in men with CKD stages 3-4.
abstract: BACKGROUND
  Hypogonadism in men (total testosterone <350 ng/dL) is associated with higher risk of cardiovascular disease and mortality in men on dialysis therapy. We evaluated the association of hypogonadism with all-cause mortality in men with non-dialysis-dependent chronic kidney disease (CKD).
  
  
  METHODS
  Retrospective, cohort study.
  
  
  METHODS
  2,419 men with CKD stages 3-4 (estimated glomerular filtration rate, 15-59 mL/min/1.73 m2) who had total testosterone measured for cause between January 1, 2005, and October 31, 2011, at a tertiary-care center in Cleveland, OH.
  
  
  METHODS
  Total testosterone measured using an immunoassay measurement in 3 forms: (1) categorized as low or testosterone replacement therapy versus normal, (2) continuous log testosterone, and (3) quintiles (100-226, 227-305, 306-392, 393-511, and 512-3,153 ng/dL).
  
  
  RESULTS
  Factors associated with low total testosterone level and the association between low total testosterone level and all-cause mortality were evaluated using logistic regression, Cox proportional hazard models, and Kaplan-Meier survival curves.
  
  
  RESULTS
  Hypogonadism was found in 1,288 of 2,419 (53%) men. In a multivariable logistic regression analysis, African American ethnicity and higher estimated glomerular filtration rate were associated with lower odds of having hypogonadism. Diabetes and higher body mass index were associated with higher odds of having hypogonadism. 357 of 2,419 (15%) patients died during a median follow-up of 2.3 years. In the multivariate Cox model, testosterone level <350 ng/dL or testosterone replacement therapy was not associated with mortality. In a multivariable model also adjusted for testosterone supplementation, higher log testosterone was associated with significantly lower mortality (HR per 1 log unit, 0.70; 95% CI, 0.55-0.89). When compared to the highest quintile, the second lowest quintile of testosterone was associated with higher mortality (HR, 1.53; 95% CI, 1.09-2.16).
  
  
  CONCLUSIONS
  Single-center study, timing of testosterone testing, lack of adjustment for proteinuria, and sampling bias.
  
  
  CONCLUSIONS
  Low total testosterone level may be associated with higher mortality in men with CKD stages 3-4, but more studies are needed.
authors.affiliation: Department of Urology, Glickman Urological & Kidney Institute, Cleveland, OH.
authors.forename: Kiranpreet K
authors.initials: KK
authors.lastname: Khurana
authors.affiliation: Department of Nephrology & Hypertension, Glickman Urological & Kidney Institute, Cleveland, OH.
authors.forename: Sankar D
authors.initials: SD
authors.lastname: Navaneethan
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH.
authors.forename: Susana
authors.initials: S
authors.lastname: Arrigain
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH.
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Schold
authors.affiliation: Department of Nephrology & Hypertension, Glickman Urological & Kidney Institute, Cleveland, OH.
authors.forename: Joseph V
authors.initials: JV
authors.lastname: Nally
authors.affiliation: Department of Urology, Glickman Urological & Kidney Institute, Cleveland, OH. Electronic address: dshoskes@gmail.com.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Shoskes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D006801:Humans; D007006:Hypogonadism / Q000150:complications; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000150:complications / Q000401:mortality*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013739:Testosterone / Q000097:blood*; D055815:Young Adult
chemical_list: D013739:Testosterone
keywords: CKD registry; Hypogonadism; chronic kidney disease (CKD); low testosterone; mortality risk; testosterone replacement therapy (TRT)
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