Serum testosterone concentrations in male patients with end-stage kidney disease treated with haemodialysis
, 1, 1
Abstract
Introduction: Testosterone deficiency is frequently found in male patients with chronic kidney disease (CKD) and may participate in the pathogenesis of osteoporosis, sarcopaenia, anaemia, impotence, infertility, and other comorbidities observed in these patients. The aim of the study was the evaluation of the frequency of testosterone deficiency in male patients with CKD on maintenance haemodialysis (HD).
Material and methods: In 79 male HD patients, serum total (TT), free (FT) testosterone, C-reactive protein (CRP), and interleukin 6 (IL-6) serum concentrations were assessed before an HD procedure. Patients were divided into three subgroups based on age categories: 19-39 years (18 patients), 40–59 years (34 patients), and ≥ 60 years (27 patients). TT insufficiency and deficiency were diagnosed when the serum TT concentration was below 4.0 ng/mL and 2.9 ng/mL, respectively. FT deficiency was diagnosed in patients with serum FT concentration below 8.9, 6.6, and 4.9 pg/mL in the abovementioned age subgroups, respectively.
Results: In the abovementioned age subgroups the serum TT concentration was 5.9 (4.6–7.1), 4.8 (3.9–5.4), and 4.6 (3.9–5.3) ng/mL, respectively. The serum FT concentration was 7.9 (5.2–10.1), 6.1 (5.1–7.2), and 6.0 (5.0–7.1) pg/mL, respectively. In the whole group TT insufficiency was found in 40%, TT deficiency in 15% of patients, and FT deficiency in 50% of patients. Significant negative correlations were found between both serum TT and FT concentrations and age (r = –0.23, p = 0.05 and r = –0.27, p = 0.02, respectively). Additionally, negative correlations were found between both serum TT and FT and IL-6 concentrations (r = –0.43, p < 0.05 and r = –0.29, p < 0.05), respectively.
Conclusions: 1. Testosterone deficiency is common in male patients with chronic kidney disease treated with HD. 2. In HD patients the serum testosterone concentration decreases with age. 3. Chronic inflammation may participate in the pathogenesis of testosterone deficiency in haemodialysis patients.
Keywords: testosterone deficiencyhypogonadismhaemodialysisend-stage kidney disease
References
- Schmidt A, Luger A, Hörl WH. Sexual hormone abnormalities in male patients with renal failure. Nephrol Dial Transplant. 2002; 17(3): 368–371.
- Araujo AB, Esche GR, Kupelian V, et al. Prevalence of symptomatic androgen deficiency in men. J Clin Endocrinol Metab. 2007; 92(11): 4241–4247.
- Carrero JJ, Qureshi AR, Nakashima A, et al. Prevalence and clinical implications of testosterone deficiency in men with end-stage renal disease. Nephrol Dial Transplant. 2011; 26(1): 184–190.
- Chiang JM, Kaysen GA, Segal M, et al. Low testosterone is associated with frailty, muscle wasting and physical dysfunction among men receiving hemodialysis: a longitudinal analysis. Nephrol Dial Transplant. 2019; 34(5): 802–810.
- Cigarrán S, Pousa M, Castro MJ, et al. Endogenous testosterone, muscle strength, and fat-free mass in men with chronic kidney disease. J Ren Nutr. 2013; 23(5): e89–e95.
- Tostain JL, Blanc F. Testosterone deficiency: a common, unrecognized syndrome. Nat Clin Pract Urol. 2008; 5(7): 388–396.
- Carrero JJ, Stenvinkel P. The vulnerable man: impact of testosterone deficiency on the uraemic phenotype. Nephrol Dial Transplant. 2012; 27(11): 4030–4041.
- Amiri M, Ramezani Tehrani F, Rahmati M, et al. Low serum testosterone levels and the incidence of chronic kidney disease among male adults: A prospective population-based study. Andrology. 2020; 8(3): 575–582.
- Dunkel L, Raivio T, Laine J, et al. Circulating luteinizing hormone receptor inhibitor(s) in boys with chronic renal failure. Kidney Int. 1997; 51(3): 777–784.
- Iglesias P, Carrero JJ, Díez JJ. Gonadal dysfunction in men with chronic kidney disease: clinical features, prognostic implications and therapeutic options. J Nephrol. 2012; 25(1): 31–42.
- Ramirez G, Butcher D, Brueggemeyer CD, et al. Testicular defect: the primary abnormality in gonadal dysfunction of uremia. South Med J. 1987; 80(6): 698–701.
- de Vries CP, Gooren LJ, Oe PL. Haemodialysis and testicular function. Int J Androl. 1984; 7(2): 97–103.
- Kuczera P, Adamczak M, Wiecek A. Changes of Serum Total and Free Testosterone Concentrations in Male Chronic Hemodialysis Patients with Secondary Hyperparathyroidism in Response to Cinacalcet Treatment. Kidney Blood Press Res. 2016; 41(1): 1–8.
- Bhasin S, Brito JP, Cunningham GR, et al. Task Force, Endocrine Society. Testosterone therapy in adult men with androgen deficiency syndromes: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2006; 91(6): 1995–2010.
- Carrero JJ, Qureshi AR, Parini P, et al. Low serum testosterone increases mortality risk among male dialysis patients. J Am Soc Nephrol. 2009; 20(3): 613–620.
- Khurana KK, Navaneethan SD, Arrigain S, et al. Serum testosterone levels and mortality in men with CKD stages 3-4. Am J Kidney Dis. 2014; 64(3): 367–374.
- Chryssicopoulos A, Koutsikos D, Kapetanaki A, et al. Evaluation of the hypothalamic-pituitary axis in uremic males using dynamic tests. The possible role of testicular inhibin: a preliminary report. Ren Fail. 1996; 18(6): 911–921.
- Holley JL. The hypothalamic-pituitary axis in men and women with chronic kidney disease. Adv Chronic Kidney Dis. 2004; 11(4): 337–341.
- Shiraishi K, Shimabukuro T, Naito K. Effects of hemodialysis on testicular volume and oxidative stress in humans. J Urol. 2008; 180(2): 644–650.
- Yu J, Ravel VA, You AS, et al. Association between Testosterone and Mortality Risk among U.S. Males Receiving Dialysis. Am J Nephrol. 2017; 46(3): 195–203.
- Hylander B, Lehtihet M. Testosterone and gonadotropins but not SHBG vary with CKD stages in young and middle aged men. Basic Clin Androl. 2015; 25(9).
- Kapoor D, Clarke S, Stanworth R, et al. The effect of testosterone replacement therapy on adipocytokines and C-reactive protein in hypogonadal men with type 2 diabetes. Eur J Endocrinol. 2007; 156(5): 595–602.
- Dudek P, Kozakowski J, Zgliczyński W. The effects of testosterone replacement therapy in men with age-dependent hypogonadism on body composition, and serum levels of leptin, adiponectin, and C-reactive protein. Endokrynol Pol. 2020; 71(5): 382–387.
- Soljancic A, Ruiz AL, Chandrashekar K, et al. Protective role of testosterone in ischemia-reperfusion-induced acute kidney injury. Am J Physiol Regul Integr Comp Physiol. 2013; 304(11): R951–R958.
- Bianchi VE. The Anti-Inflammatory Effects of Testosterone. J Endocr Soc. 2019; 3(1): 91–107.
- Trembecki J, Kokot F, Wiecek A, et al. [Influence of long-term erythropoietin (rHuEPO) therapy on the function of the pituitary-gonadal axis in hemodialyzed male patients with end stage renal failure]. Pol Arch Med Wewn. 1995; 94(2): 144–152.
- Trembecki J, Kokot F, Wiecek A, et al. [Improvement of sexual function in hemodialyzed male patients with chronic renal failure treated with erythropoietin (rHuEPO)]. Przegl Lek. 1995; 52(9): 462–466.
