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

Abstract

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.

Prevalence of subnormal testosterone concentrations in men with type 2 diabetes and chronic kidney disease

“…Since T concentrations can decline by 30% as the day progresses, this would falsely increase the prevalence of subnormal T concentrations. Overall, the literature suggests that approximately half of men with ESRD have low total T concentrations and approximately one-third of men with milder forms of renal failure have low total T. These studies also found that the total T concentrations were lower in men with type 2 diabetes and CKD as compared to men without diabetes and CKD (10,11,12,29). These studies have used immunoassays to measure total T concentrations in men with CKD.…”

“…Total T concentrations are decreased in men with chronic kidney disease (CKD) (8,9,10,11,12,13). Endocrine society considers CKD and type 2 diabetes as conditions associated with a high prevalence of low T concentrations (5).…”

Effect of ADMA levels on severity of erectile dysfunction in chronic kidney disease and other risk factors

“…26,27 Yılmaz et al reported lower levels of testosterone in patients with CKD, even at early stages of the disease. 28 In our group of patients with CKD, the serum levels of testosterone were significantly lower than the control group. Although mean serum testosterone levels were lower in group 1 than group 2, there was no statistical difference between both groups with CKD.…”

“…The degree of ED was divided into five categories: no ED (scores of [26][27][28][29][30], mild (scores of [22][23][24][25], mild-to-moderate (scores of 17-21), moderate (scores of [11][12][13][14][15][16], and severe (scores of 6-10). 12 Groups were composed as follows: group1: patients with CKD and ED; group 2: patients with CKD without ED; group 3: control patients without CKD or ED.…”

Shear Wave Sonoelastography Findings of Testicles in Chronic Kidney Disease Patients Who Undergo Hemodialysis

“…Because testosterone is an efficient anabolic hormone, its deficiency causes not only problems related to libido but also several important cardiometabolic side effects. These side effects include deterioration in cognitive functions, decrease in muscle mass, endothelial dysfunction, cardiovascular events, and an increase in the risk of death [25][26][27][28]. In a study conducted on 1822 male patients, Haring et al [28] demonstrated that low levels of total testosterone significantly increased mortality.…”