Androgen Deficiency and Endothelial Dysfunction in Men with End-Stage Kidney Disease Receiving Maintenance Hemodialysis

Karakitsos, Dimitrios; Patrianakos, Alexandros; Groot, Eric de; Boletis, John; Karabinis, Andréas; Kyriazis, John; Samonis, George; Parthenakis, F.; Vardas, Panos; Daphnis, Eugene

doi:10.1159/000097816

Cited by 56 publications

(41 citation statements)

References 89 publications

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“…Testosterone deficiency may have impact on endothelial dysfunction and therewith being an etiological factor in ED. 25 To elucidate the molecular mechanisms of hypogonadism in men with ESRD, Dunkel et al 26 tested the capacity of serum from ESRD patients to inhibit recombinant human LH receptor activity. Using a cell line expressing functional human LH receptors, they found that adenosine 3 0 5 0 -monophosphate production was markedly inhibited by sera from the patients, compared to sera from healthy subjects.…”

Section: Discussionmentioning

confidence: 99%

“…The score for each item ranges from 0 to 5 for questions 1-10, 0 meaning no sexual activity/no attempt to have sexual intercourse, and from 1 to 5 for questions [11][12][13][14][15]. The severity of ED was classified using five categories: no ED (EF score: 26-30), mild (EF score: [22][23][24][25], mild to moderate (EF score: 17-21), moderate (EF score: 11-16) and severe (EF score: 6-10). 15 At baseline complete blood count, serum creatinine, albumin, PSA, alanine aminotransferase and serum hormone levels including follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), total and free T, sex hormone binding globulin (SHBG) and intact parathyroid hormone were measured.…”

Section: Methodsmentioning

confidence: 99%

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Efficacy of testosterone gel in the treatment of erectile dysfunction in hypogonadal hemodialysis patients: a pilot study

Cangüven¹,

Aykose²,

Albayrak³

et al. 2009

Int J Impot Res

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End-stage renal disease (ESRD) affects sexual function. The etiology of sexual dysfunction in ESRD is multifactorial and hypogonadism is not uncommon. In a cohort of 96 men with ESRD, scores on International Index of Erectile Function (IIEF) correlated with bioavailable testosterone (T; Po0.01). We further evaluated the effects of administration of T on ED in hypogonadal men on hemodialysis. Nine men with ED and hypogonadism (baseline bioavailable T o3.82 nmol l À1 ), received 5 g T-gel (1% (10 mg g À1 ) per day treatment for 6 months. The IIEF and frequency of sexual intercourse per week were used to assess treatment efficacy. T administration significantly increased serum T levels to the normal range, and was associated with statistically significant improvements of the scores of the IIEF domains (erectile function from 7.6 ± 8.0 to 12.8 ± 7.8; intercourse satisfaction from 3.4 ± 4.5 to 4.8 ± 3.1; orgasmic function from 4.8 ± 3.1 to 3.4±2.9; sexual desire from 3.4±2.9 to 4.4±0.6; overall sexual satisfaction from 2.6±1.3 to 3.8±1.0). But scores of the IIEF did not normalize. Frequency of weekly sexual intercourse increased from 0.4 ± 0.4 to 1.1 ± 0.8 (Po0.05) after 6 months. There were no adverse effects. We conclude that restoring T levels to normal in men with ESRD improved scores on the IIEF and frequency of weekly sexual intercourse.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Efficacy of testosterone gel in the treatment of erectile dysfunction in hypogonadal hemodialysis patients: a pilot study

Cangüven¹,

Aykose²,

Albayrak³

et al. 2009

Int J Impot Res

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“…It has recently been reported that low endogenous testosterone values were also associated with increased risk of death in male hemodialysis patients (7,8). Interestingly, testosterone deficiency in men undergoing hemodialysis has also been related to arterial thickening, atherosclerotic plaque occurrence, and reduced flowmediated dilation (FMD) (9). The high prevalence and amenability to intervention makes hypogonadism an attractive potential therapeutic target in CKD men, meriting further investigation.…”

Section: Introductionmentioning

confidence: 99%

Endogenous Testosterone, Endothelial Dysfunction, and Cardiovascular Events in Men with Nondialysis Chronic Kidney Disease

Yılmaz

Sönmez

Qureshi

et al. 2011

Clinical Journal of the American Society of Nephrology

107

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SummaryBackground and objectives Deterioration of kidney function impairs testosterone production, with hypogonadism being common in men with chronic kidney disease (CKD). In nonrenal populations, testosterone is suggested to participate in the atherosclerotic process. In male dialysis patients, we showed that low testosterone increases the risk of mortality. We here studied plausible links among testosterone levels, vascular derangements, and cardiovascular events in nondialysis CKD men.Design, setting, participants, & methods This was a cross-sectional analysis in which flow-mediated dilation (FMD) was assessed in 239 CKD male patients (stages 1 to 5; mean age 52 Ϯ 12 years), together with routine measurements, serum total and free testosterone, and follow-up for cardiovascular outcomes.Results Total and free testosterone levels decreased in parallel with the reduction of kidney function. Multiple regression analyses showed that total and free testosterone significantly and independently contributed to explain the variance of FMD. After a median follow-up of 31 months (range 8 to 35 months), 22 fatal and 50 nonfatal cardiovascular events occurred. In Cox analysis, the risk of cardiovascular events was reduced by 22% for each nanomole-per-liter increment of total testosterone. This reduced risk persisted after adjustment for age, renal function, diabetes mellitus, previous cardiovascular history, C-reactive protein, albumin, and FMD. The same was true for free testosterone concentrations. ConclusionsThe reduction in endogenous testosterone levels observed with progressive CKD was inversely associated with endothelial dysfunction and exacerbated the risk of future cardiovascular events in nondialysis male CKD patients.

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“…In a small study that included male HD patients without diabetes, low testosterone levels were associated with endothelial dysfunction and atherosclerosis (15). Interestingly, Carrero et al (16) recently demonstrated in a Swedish HD cohort that low serum testosterone levels were significant predictors of mortality, irrespective of age and inflammation, but this was abolished after correction for serum creatinine, used there as a surrogate of muscle mass (16).…”

mentioning

confidence: 99%

Endogenous Testosterone and Mortality in Male Hemodialysis Patients

Güngör

Kırçelli

Carrero

et al. 2010

Clinical Journal of the American Society of Nephrology

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Background and objectives: Low serum testosterone levels in hemodialysis (HD) patients have recently been associated with cardiovascular risk factors and increased mortality. To confirm this observation, we investigated the predictive role of serum total testosterone levels on mortality in a large group of male HD patients from Turkey.Design, settings, participants, & measurements: A total of 420 prevalent male HD patients were sampled in March 2005 and followed up for all-cause mortality. Serum total testosterone levels were measured by ELISA at baseline and studied in relation to mortality and cardiovascular risk profile.Results: Mean testosterone level was 8.69 ؎ 4.10 (0.17 to 27.40) nmol/L. A large proportion of patients (66%) had testosterone deficiency (<10 nmol/L). In univariate analysis, serum testosterone levels were positively correlated with creatinine and inversely correlated with age, body mass index, and lipid parameters. During an average follow-up of 32 months, 104 (24.8%) patients died. The overall survival rate was significantly lower in patients within the low testosterone tertile (<6.8 nmol/L) compared with those within the high tertile (>10.1 nmol/L; 64 versus 81%; P ‫؍‬ 0.004). A 1-nmol/L increase in serum testosterone level was associated with a 7% decrease in overall mortality (hazard ratio 0.93; 95% confidence interval 0.89 to 0.98; P ‫؍‬ 0.01); however, this association was dependent on age and other risk factors in adjusted Cox regression analyses.Conclusions: Testosterone deficiency is common in male HD patients. Although testosterone levels, per se, predicted mortality in this population, this association was largely dependent on age.

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Androgen Deficiency and Endothelial Dysfunction in Men with End-Stage Kidney Disease Receiving Maintenance Hemodialysis

Cited by 56 publications

References 89 publications

Efficacy of testosterone gel in the treatment of erectile dysfunction in hypogonadal hemodialysis patients: a pilot study

Efficacy of testosterone gel in the treatment of erectile dysfunction in hypogonadal hemodialysis patients: a pilot study

Endogenous Testosterone, Endothelial Dysfunction, and Cardiovascular Events in Men with Nondialysis Chronic Kidney Disease

Endogenous Testosterone and Mortality in Male Hemodialysis Patients

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