Low Testosterone Means Higher Mortality with CKD

A new study finds low testosterone is associated with higher mortality in men with stages 3-4 chronic kidney disease.

From 2005 to 2011, researchers from the Cleveland Clinic conducted a review of 26,400 men with confirmed stage 3-4 chronic disease, with the objective of evaluating the connection between hypogonadism and all-cause mortality in men with non-dialysis dependent chronic kidney disease.

The investigators conducted a review of a validated chronic kidney disease registry for men with stages 3-4 chronic kidney disease who had total testosterone measured, using a logistic regression analysis to evaluate association of age, ethnicity, estimated glomerular filtration rate (eGFR), body mass index, smoking, and comorbidities with low total testosterone.
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Among the participants, total testosterone was measured in 3,111, or 11.8 percent, of men, with 478 men not fitting the researchers’ inclusion criteria. In the cohort of for-cause testosterone testing in symptomatic men, hypogonadism was defined as TT<350 NG/DL, and was found in 54 percent of men. Low total testosterone was found in approximately half the men in each decade of life from age 20 to age 90. In a multi-variable logistic regression analysis, African-American ethnicity and higher eGFR were associated with significantly lower odds of having low total testosterone. Having diabetes and higher body mass index were associated with much higher odds of having low total testosterone.

The authors concluded that, while low total testosterone is associated with much higher mortality in men with stages 3-4 chronic kidney disease, it is yet unknown whether testosterone replacement therapy in this population can improve survival.

The study’s findings “should prompt primary care physicians to consider ordering a serum testosterone in their patients with renal dysfunction,” says Daniel Shoskes, MD, an attending urologist at the Cleveland Clinic, and co-author of the study, “and consider therapy if they have target symptoms, such as anemia, fatigue, erectile dysfunction, and low libido.”

The findings were presented at the American Urological Association 2014 Annual Meeting, held May 16 – 21 in Orlando, Fla.

—Mark McGraw