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

Abstract

Objectives and Methods: Two thirds of men with end-stage kidney disease (ESKD) have serum testosterone levels in the hypogonadal range. We examined if low serum testoster- one levels were correlated with measures of endothelial dysfunction in ESKD. Bilateral common carotid artery (CCA) intima-media thickness (IMT) and atherosclerotic plaque occurrence, left ventricular mass index, flow- (FMD) and nitrate-mediated vasodilatation (NMD) of the brachial artery were determined by ultrasound imaging in 100 nondiabetic men with ESKD (50 men exhibited androgen deficiency; serum testosterone concentrations <300 ng/dl). Results: Left-ventricular mass index, CCA diameter, CCA-IMT and atherosclerotic plaque occurrence were all significantly increased in ESKD patients with androgen deficiency compared with patients without androgen deficiency (p < 0.05). Also, FMD and NMD measurements were significantly reduced in the former compared with the latter (p < 0.05). Testosterone levels were inversely correlated with age and duration of hemodialysis therapy (r = –0.44 and r = –0.55; p < 0.001). Testosterone levels were negatively correlated to CCA-IMT and atherosclerotic plaque occurrence in patients with androgen deficiency (r = –0.32, p < 0.003, and r = –0.23, p < 0.04, respectively). FMD and NMD measurements were positively correlated to total (r = 0.65 and r = 0.61; both p < 0.0001) and free (r = 0.52 and r = 0.48; both p < 0.001) testosterone levels in patients with low androgenicity. Conclusion: The present results indicated that ESKD patients with androgen deficiency had increased CCA-IMT, atherosclerotic plaque occurrence and reduced FMD and NMD compared with patients without androgen deficiency. Testosterone serum levels were negatively correlated to CCA-IMT and positively correlated to endothelium-dependent vasodilatation in ESKD patients with androgen deficiency.

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

“…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.…”

“…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.…”

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

“…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.…”

Endogenous Testosterone and Mortality in Male Hemodialysis Patients

“…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).…”