title: Hypogonadism associated with muscle atrophy, physical inactivity and ESA hyporesponsiveness in men undergoing haemodialysis.
abstract: BACKGROUND
  Testosterone deficiency (hypogonadism) is common among men undergoing haemodialysis, but its clinical implications are not well characterized. Testosterone is an anabolic hormone that induces erythrocytosis and muscle synthesis. We hypothesized that testosterone deficiency would be associated with low muscle mass, physical inactivity and higher dosages of erythropoietin-stimulating agents (ESA).
  
  
  METHODS
  Single-center cross-sectional study of 57 male haemodialysis patients. None of the patients was undergoing testosterone replacement therapy. Total testosterone was measured in serum. Body composition (by bioelectrical impedance analysis) and physical activity (by the use of pedometers) were assessed. Patients with testosterone levels below the normal range were considered hypogonadal.
  
  
  RESULTS
  Mean testosterone level was 321±146ng/dL; 20 patients (35%) were hypogonadal. Hypogonadal patients were older and had lower mean arterial blood pressure, higher interleukin-6 levels, lower lean body mass and higher fat body mass. A negative association between testosterone and normalized ESA dose was found in uni- and multivariate regression analyses. Testosterone levels directly correlated with lean body mass regardless of confounders. Hypogonadal patients had lower physical activity than their counterparts [2753±1784 vs. 4291±3225steps/day (p=0.04)]. The relationship between testosterone and physical activity was independent of age, comorbidities and inflammatory markers, but dependent on the proportion of muscle mass.
  
  
  CONCLUSIONS
  Hypogonadism is common in our male haemodialysis population and is associated with higher ESA doses, reduced muscle mass and lower physical activity. The link between low testosterone levels and physical inactivity may conceivably relate to reduced muscle mass due to inadequate muscle protein synthesis.
authors.affiliation: Department of Nephrology, Hospital Severo Ochoa, Leganes, Madrid, Spain; Divisions of Renal Medicine and Baxter Novum, CLINTEC, Karolinska Institutet, Stockholm, Sweden. Electronic address: gabriela.cobo@ki.se.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Cobo
authors.affiliation: Department of Nephrology, Hospital Severo Ochoa, Leganes, Madrid, Spain.
authors.forename: Paloma
authors.initials: P
authors.lastname: Gallar
authors.affiliation: Department of Nephrology, Hospital Severo Ochoa, Leganes, Madrid, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Di Gioia
authors.affiliation: Department of Biochemistry, Hospital Severo Ochoa, Leganes, Madrid, Spain.
authors.forename: Concepción
authors.initials: C
authors.lastname: García Lacalle
authors.affiliation: Department of Nephrology, Hospital Severo Ochoa, Leganes, Madrid, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Camacho
authors.affiliation: Department of Nephrology, Hospital Severo Ochoa, Leganes, Madrid, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Rodriguez
authors.affiliation: Department of Nephrology, Hospital Severo Ochoa, Leganes, Madrid, Spain.
authors.forename: Olimpia
authors.initials: O
authors.lastname: Ortega
authors.affiliation: Department of Nephrology, Hospital Severo Ochoa, Leganes, Madrid, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Mon
authors.affiliation: Department of Nephrology, Hospital Severo Ochoa, Leganes, Madrid, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Vigil
authors.affiliation: Divisions of Renal Medicine and Baxter Novum, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Bengt
authors.initials: B
authors.lastname: Lindholm
authors.affiliation: Divisions of Renal Medicine and Baxter Novum, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Juan Jesús
authors.initials: JJ
authors.lastname: Carrero
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000188:drug therapy / Q000209:etiology; D001823:Body Composition; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004351:Drug Resistance; D015444:Exercise; D006397:Hematinics / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007006:Hypogonadism / Q000209:etiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009133:Muscular Atrophy / Q000209:etiology* / Q000473:pathology; D006435:Renal Dialysis / Q000009:adverse effects*; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000628:therapy; D013739:Testosterone / Q000097:blood
chemical_list: D006397:Hematinics; D013739:Testosterone
keywords: Actividad física; Haemodialysis; Hemodiálisis; Physical activity; Testosterona; Testosterone