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Low testosterone levels negatively affect mortality risk among males on dialysis, new data reveal

Tuesday, February 10 2009 | Comments

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What's This? Among men on hemodialysis, lower levels of testosterone are associated with a higher risk of all-cause mortality and cardiovascular disease (CVD)-related mortality, study results indicate.

Men who undergo treatment with dialysis have an elevated risk of premature CVD, and in the general population, low concentrations of testosterone have been linked to cardiovascular risk, the authors of the study noted.

To assess the relationship between testosterone concentration and mortality in this patient population, the authors conducted a prospective observational study of a cohort of 126 men (median age, 63 yrs; range, 29-86 yrs) who were undergoing dialysis during a mean period of 41 months.

Of the cohort, 66 men (52%) had testosterone deficiency (<10 nmol/L), 39 (32%) had testosterone levels in the lower normal range (10 nmol/L to 14 nmol/L), and 21 (16%) had normal levels.

Among the patients with a clinical history of CVD, testosterone levels were significantly lower than those among the patients with no history of CVD (9.4 nmol/L vs 12.0 nmol/L; P=.003). The associations between testosterone and clinical CVD were independent of age and levels of sex hormone-binding globulin.

A total of 65 patients (51%) died during the follow-up period. Of these deaths, 38 (58%) were from CVD-related causes. Baseline testosterone levels were lower among the patients who died from CVD-related causes than among those who died from non-CVD-related causes (8.0 nmol/L vs 11.0 nmol/L; P<.05).

A separate analysis showed that patients with testosterone levels below the 33rd percentile had more than double the mortality risk (hazard ratio [HR], 2.03; 95% CI, 1.24-3.31; P=.004) and 3 times the risk of death from CVD-related causes (HR, 3.19; 95% CI, 1.49-6.83; P=.008) relative to patients with higher levels. The prognostic value of low testosterone concentrations persisted after correcting for numerous variables; however, further adjustment for serum creatinine caused the value to lose significance.

"[W]e report for the first time that testosterone concentrations are inversely related to mortality due to both CVD and all causes in male patients [being treated with hemodialysis]," the authors concluded. "Because this association is lost after adjusting for serum creatinine, our data suggest that hypogonadism and muscle wasting are closely related."

The study was published online Jan. 14 ahead of print in the Journal of the American Society of Nephrology by Carrero JJ, et al.

Data used in this study were derived from the MIMICK study, which was supported by Amgen Inc.

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