Background
Hypogonadism in men (total testosterone level < 350 ng/dL) is associated with higher risk of cardiovascular disease and mortality in men on dialysis. We evaluated the association of hypogonadism with all-cause mortality in men with non–dialysis-dependent CKD.
Study Design
Retrospective, cohort study.
Setting & Participants
2419 men with CKD stages 3–4 (estimated glomerular filtration rate [eGFR], 15–59 mL/min/1.73 m2) who had total testosterone measured for-cause between January 1, 2005 and October 31, 2011 at a tertiary care center in Cleveland, Ohio.
Predictors
Total testosterone measured using an immunoassay measurement in 3 forms: a) categorized as low or testosterone replacement therapy versus normal, b) continuous log testosterone, and c) quintiles (100–226, 227–305, 306–392, 393–511, 512–3153 ng/dL).
Outcomes
Factors associated with low total testosterone, and association between low total testosterone and all-cause mortality were evaluated using logistic regression, Cox proportional hazard models, and Kaplan-Meier survival curves.
Results
Hypogonadism was found in 1288/2419 (53%) of men. In a multivariable logistic regression analysis, African American ethnicity and higher eGFR were associated with lower odds of having hypogonadism. Diabetes and higher body mass index were associated with higher odds of having hypogonadism. 357/2419 (15%) patients died during a median follow up of 2.3 years. In the multivariate Cox model, testosterone <350 ng/dL or testosterone replacement therapy were not associated with mortality. In a multivariable model also adjusted for testosterone supplementation, higher log testosterone was associated with significantly lower mortality (HR per 1 log unit, 0.70; 95% CI, 0.55–0.89). When compared to the highest quintile, the second lowest quintile of testosterone was associated with higher mortality (HR, 1.53; 95% CI, 1.09–2.16).
Limitations
Single center study, timing of testosterone testing, lack of adjustment for proteinuria, and sampling bias.
Conclusions
Low total testosterone may be associated with higher mortality in men with CKD stages 3–4 but more studies are needed.