Login to MyKarger

New to MyKarger? Click here to sign up.



Login with Facebook

Forgot your password?

Authors, Editors, Reviewers

For Manuscript Submission, Check or Review Login please go to Submission Websites List.

Submission Websites List

Institutional Login
(Shibboleth or Open Athens)

For the academic login, please select your country in the dropdown list. You will be redirected to verify your credentials.

Original Report: Patient-Oriented, Translational Research

Association between Testosterone and Mortality Risk among U.S. Males Receiving Dialysis

Yu J.a · Ravel V.A.a · You A.S.a · Streja E.a · Rivara M.B.b · Potukuchi P.K.e · Brunelli S.M.c · Kovesdy C.P.d, e · Kalantar-Zadeh K.a · Rhee C.M.a

Author affiliations

aHarold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, CA, bKidney Research Institute and Harborview Medical Center, Division of Nephrology, University of Washington, Seattle, WA, cDaVita Clinical Research, Minneapolis, MN, and dMemphis Veterans Affairs Medical Center, and eDivision of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA

Related Articles for ""

Am J Nephrol 2017;46:195-203

Do you have an account?

Login Information





Contact Information












By signing up for MyKarger you will automatically participate in our year-End raffle.
If you Then Do Not wish To participate, please uncheck the following box.

Yes, I wish To participate In the year-End raffle And Get the chance To win some Of our most interesting books, And other attractive prizes.


I have read the Karger Terms and Conditions and agree.



Login Information





Contact Information












By signing up for MyKarger you will automatically participate in our year-End raffle.
If you Then Do Not wish To participate, please uncheck the following box.

Yes, I wish To participate In the year-End raffle And Get the chance To win some Of our most interesting books, And other attractive prizes.


I have read the Karger Terms and Conditions and agree.



To view the fulltext, please log in

To view the pdf, please log in

Buy

  • FullText & PDF
  • Unlimited re-access via MyKarger
  • Unrestricted printing, no saving restrictions for personal use
read more

CHF 38.00 *
EUR 35.00 *
USD 39.00 *

Select

KAB

Buy a Karger Article Bundle (KAB) and profit from a discount!

If you would like to redeem your KAB credit, please log in.


Save over 20% compared to the individual article price.
Learn more

Rent/Cloud

  • Rent for 48h to view
  • Buy Cloud Access for unlimited viewing via different devices
  • Synchronizing in the ReadCube Cloud
  • Printing and saving restrictions apply

Rental: USD 8.50
Cloud: USD 20.00


Select

Subscribe

  • Access to all articles of the subscribed year(s) guaranteed for 5 years
  • Unlimited re-access via Subscriber Login or MyKarger
  • Unrestricted printing, no saving restrictions for personal use
read more

Subcription rates


Select

* The final prices may differ from the prices shown due to specifics of VAT rules.

Article / Publication Details

First-Page Preview
Abstract of Original Report: Patient-Oriented, Translational Research

Received: March 24, 2017
Accepted: August 08, 2017
Published online: September 01, 2017
Issue release date: September 2017

Number of Print Pages: 9
Number of Figures: 2
Number of Tables: 2

ISSN: 0250-8095 (Print)
eISSN: 1421-9670 (Online)

For additional information: https://www.karger.com/AJN

Abstract

Background: Among the general population, low circulating testosterone levels are associated with higher risk of cardiovascular disease and death. While testosterone deficiency is common in dialysis patients, studies of testosterone and mortality in this population are ambiguous and overlapping. We hypothesized that lower testosterone levels are associated with higher mortality in male dialysis patients. Methods: We examined a nationally representative cohort of male dialysis patients from a large US dialysis organization who underwent one or more total testosterone measurements from 1/2007 to 12/2011. The association between total testosterone categorized as quartiles and all-cause mortality was studied using Cox models adjusted for expanded case-mix and laboratory covariates. We also examined total testosterone as a continuous predictor of all-cause mortality using restricted cubic splines. Results: Among 624 male dialysis patients, 51% of patients demonstrated testosterone deficiency (total testosterone <300 ng/dL); median (IQR) total testosterone levels were 297 (190-424) ng/mL. In expanded case-mix + laboratory adjusted Cox analyses, we observed a graded association between lower testosterone levels and higher mortality risk (ref: quartile 3): adjusted hazard ratios (95% CI) 2.32 (1.33-4.06), 1.80 (0.99-3.28), and 0.68 (0.32-1.42) for Quartiles 1, 2, and 4, respectively. In adjusted spline analyses, the lower testosterone-higher mortality risk association declined with higher testosterone levels until the value reached a threshold of 400 ng/dL above which risk plateaued. Conclusion: Lower testosterone levels were independently associated with higher mortality risk in male dialysis patients. Further studies are needed to determine underlying mechanisms, and whether testosterone replacement ameliorates death risk in this population.

© 2017 S. Karger AG, Basel


References

  1. Araujo AB, Kupelian V, Page ST, Handelsman DJ, Bremner WJ, McKinlay JB: Sex steroids and all-cause and cause-specific mortality in men. Arch Intern Med. 2007;167:1252-1260.
  2. Harman SM, Metter EJ, Tobin JD, Pearson J, Blackman MR: Longitudinal effects of aging on serum total and free testosterone levels in healthy men. Baltimore Longitudinal Study of Aging. J Clin Endocrinol Metab 2001;86:724-731.
  3. Laughlin GA, Barrett-Connor E, Bergstrom J: Low serum testosterone and mortality in older men. J Clin Endocrinol Metab 2008;93:68-75.
  4. Sharma R, Oni OA, Gupta K, Chen G, Sharma M, Dawn B, Sharma R, Parashara D, Savin VJ, Ambrose JA, Barua RS: Normalization of testosterone level is associated with reduced incidence of myocardial infarction and mortality in men. Eur Heart J 2015;36:2706-2715.
  5. Yeap BB, Alfonso H, Chubb SA, Handelsman DJ, Hankey GJ, Almeida OP, Golledge J, Norman PE, Flicker L: In older men an optimal plasma testosterone is associated with reduced all-cause mortality and higher dihydrotestosterone with reduced ischemic heart disease mortality, while estradiol levels do not predict mortality. J Clin Endocrinol Metab 2014;99:E9-E18.
  6. Kakiya R, Shoji T, Hayashi T, Tatsumi-Shimomura N, Tsujimoto Y, Tabata T, Shima H, Mori K, Fukumoto S, Tahara H, Koyama H, Emoto M, Ishimura E, Nishizawa Y, Inaba M: Decreased serum adrenal androgen dehydroepiandrosterone sulfate and mortality in hemodialysis patients. Nephrol Dial Transplant 2012;27:3915-3922.
  7. URD System: USRDS 2013 Annual Data Report: Atlas of Chronic Kidney DIsease and End-Stage Renal Disease in the United States. Bethesda, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2013.
  8. Carrero JJ, Qureshi AR, Nakashima A, Arver S, Parini P, Lindholm B, Barany P, Heimburger O, Stenvinkel P: Prevalence and clinical implications of testosterone deficiency in men with end-stage renal disease. Nephrol Dial Transplant 2011;26:184-190.
  9. Gungor O, Kircelli F, Carrero JJ, Asci G, Toz H, Tatar E, Hur E, Sever MS, Arinsoy T, Ok E: Endogenous testosterone and mortality in male hemodialysis patients: is it the result of aging? Clin J Am Soc Nephrol 2010;5:2018-2023.
  10. Carrero JJ: Testosterone deficiency at the crossroads of cardiometabolic complications in CKD. Am J Kidney Dis 2014;64:322-325.
  11. Malkin CJ, Pugh PJ, Jones RD, Kapoor D, Channer KS, Jones TH: The effect of testosterone replacement on endogenous inflammatory cytokines and lipid profiles in hypogonadal men. J Clin Endocrinol Metab 2004;89:3313-3318.
  12. Schmidt A, Luger A, Horl WH: Sexual hormone abnormalities in male patients with renal failure. Nephrol Dial Transplant 2002;17:368-371.
  13. Bello AK, Stenvinkel P, Lin M, Hemmelgarn B, Thadhani R, Klarenbach S, Chan C, Zimmerman D, Cembrowski G, Strippoli G, Carrero JJ, Tonelli M: Serum testosterone levels and clinical outcomes in male hemodialysis patients. Am J Kidney Dis 2014;63:268-275.
  14. Carrero JJ, Qureshi AR, Parini P, Arver S, Lindholm B, Barany P, Heimburger O, Stenvinkel P: Low serum testosterone increases mortality risk among male dialysis patients. J Am Soc Nephrol 2009;20:613-620.
  15. Grossmann M, Hoermann R, Ng Tang Fui M, Zajac JD, Ierino FL, Roberts MA: Sex steroids levels in chronic kidney disease and kidney transplant recipients: associations with disease severity and prediction of mortality. Clin Endocrinol (Oxf) 2015;82:767-775.
  16. Kyriazis J, Tzanakis I, Stylianou K, Katsipi I, Moisiadis D, Papadaki A, Mavroeidi V, Kagia S, Karkavitsas N, Daphnis E: Low serum testosterone, arterial stiffness and mortality in male haemodialysis patients. Nephrol Dial Transplant 2011;26:2971-2977.
  17. Kuttykrishnan S, Kalantar-Zadeh K, Arah OA, Cheung AK, Brunelli S, Heagerty PJ, Katz R, Molnar MZ, Nissenson A, Ravel V, Streja E, Himmelfarb J, Mehrotra R: Predictors of treatment with dialysis modalities in observational studies for comparative effectiveness research. Nephrol Dial Transplant 2015;30:1208-1217.
  18. Rhee CM, Kim S, Gillen DL, Oztan T, Wang J, Mehrotra R, Kuttykrishnan S, Nguyen DV, Brunelli SM, Kovesdy CP, Brent GA, Kalantar-Zadeh K: Association of thyroid functional disease with mortality in a national cohort of incident hemodialysis patients. J Clin Endocrinol Metab 2015;100:1386-1395.
  19. Bhasin S, Cunningham GR, Hayes FJ, Matsumoto AM, Snyder PJ, Swerdloff RS, Montori VM: Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2010;95:2536-2559.
  20. Haffner SM, Mykkanen L, Valdez RA, Katz MS: Relationship of sex hormones to lipids and lipoproteins in nondiabetic men. J Clin Endocrinol Metab 1993;77:1610-1605.
  21. Ohlsson C, Barrett-Connor E, Bhasin S, Orwoll E, Labrie F, Karlsson MK, Ljunggren O, Vandenput L, Mellstrom D, Tivesten A: High serum testosterone is associated with reduced risk of cardiovascular events in elderly men. The MrOS (Osteoporotic Fractures in Men) study in Sweden. J Am Coll Cardiol 2011;58:1674-1681.
  22. Kaplan SA, Johnson-Levonas AO, Lin J, Shah AK, Meehan AG: Elevated high sensitivity C-reactive protein levels in aging men with low testosterone. Aging Male 2010;13:108-112.
  23. Laaksonen DE, Niskanen L, Punnonen K, Nyyssonen K, Tuomainen TP, Valkonen VP, Salonen R, Salonen JT: Testosterone and sex hormone-binding globulin predict the metabolic syndrome and diabetes in middle-aged men. Diabetes care. 2004;27:1036-1041.
  24. Yilmaz MI, Sonmez A, Qureshi AR, Saglam M, Stenvinkel P, Yaman H, Eyileten T, Caglar K, Oguz Y, Taslipinar A, Vural A, Gok M, Unal HU, Yenicesu M, Carrero JJ: Endogenous testosterone, endothelial dysfunction, and cardiovascular events in men with nondialysis chronic kidney disease. Clin J Am Soc Nephrol 2011;6:1617-1625.
  25. Carrero JJ, Barany P, Yilmaz MI, Qureshi AR, Sonmez A, Heimburger O, Ozgurtas T, Yenicesu M, Lindholm B, Stenvinkel P: Testosterone deficiency is a cause of anaemia and reduced responsiveness to erythropoiesis-stimulating agents in men with chronic kidney disease. Nephrol Dial Transplant. 2012;27:709-715.
  26. Rhee CM, Lertdumrongluk P, Streja E, Park J, Moradi H, Lau WL, Norris KC, Nissenson AR, Amin AN, Kovesdy CP, Kalantar-Zadeh K: Impact of age, race and ethnicity on dialysis patient survival and kidney transplantation disparities. Am J Nephrol 2014;39:183-194.
  27. Johansen KL, Mulligan K, Schambelan M. Anabolic effects of nandrolone decanoate in patients receiving dialysis: a randomized controlled trial. JAMA 1999;281:1275-1281.
  28. Ghorbanihaghjo A, Argani H, Rohbaninoubar M, Rashtchizadeh N: Effect of Nandrolone Decanoate on serum lipoprotein (a) and its isoforms in hemodialysis patients. Lipids Health Dis 2004;3:16.
  29. Adamu B, Ma'aji SM, Erwin PJ, Tleyjeh IM: Meta-Analysis of Randomized controlled trials on androgens versus erythropoietin for anaemia of chronic kidney disease: implications for developing Countries. Int J Nephrol 2012;2012:580437.
  30. Haring R, Nauck M, Volzke H, Endlich K, Lendeckel U, Friedrich N, Dorr M, Rettig R, Kroemer HK, Wallaschofski H Low serum testosterone is associated with increased mortality in men with stage 3 or greater nephropathy. Am J Nephrol 2011;33:209-217.

Article / Publication Details

First-Page Preview
Abstract of Original Report: Patient-Oriented, Translational Research

Received: March 24, 2017
Accepted: August 08, 2017
Published online: September 01, 2017
Issue release date: September 2017

Number of Print Pages: 9
Number of Figures: 2
Number of Tables: 2

ISSN: 0250-8095 (Print)
eISSN: 1421-9670 (Online)

For additional information: https://www.karger.com/AJN


Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.