Is Free Testosterone Concentration a Prognostic Factor of Survival in Chronic Renal Failure (CRF)?

Abstract

BackgroundLowered testosterone level in CRF patients is associated with elevated risk of death due to cardiovascular reasons, and is influenced by many factors, including acid-base balance disorders. Aims: evaluation of testosterone concentration (TT) and free testosterone concentration (fT) in pre-dialysis and dialysis patients; assessment of TT and fT relationships with biochemical parameters; evaluation of prognostic importance of TT and fT in predicting patient survival.Material/Methods4 groups of men: 14 – on hemodialysis (HD), 13 – on peritoneal dialysis (PD), 9 – with chronic renal failure (CRF) and 8 – healthy (CG), aged 56±17, 53±15, 68±12, 43±10 years, respectively. TT and biochemical parameters were measured; fT was calculated.ResultsThe lowest TT and fT were observed in HD and CRF, the highest – in CG (p=0.035 for TT; p=0.007 for fT). fT in CRF and CG were different (p=0.031). TT and age was associated in HD (p=0.026). Age and fT was strongly associated in PD (p<0.001). After adjustment for age, TT was negatively associated with BMI (p=0.013) and fT was positively associated with HCO3 level (p=0.007). fT was lower in those who died during 5 years of observation than in survivors (p=0.009). We have found that, opposite to TT, fT appeared to be a better predictor of 5-year survival than age. After combining pH and HCO3 levels into a single variable – no acidosis, acidosis with HCO3 normal serum level, acidosis with low concentrations of HCO3 and adjustment for age and the study group – a trend toward the lowest values of free testosterone in decompensated acidosis was observed (ptrend=0.027). Such a trend was not seen for testosterone concentrations (ptrend=0.107).ConclusionsTotal and free testosterone levels were lower in HD and pre-dialysis than in healthy patients. Free testosterone level may predict long-term survival better than age. Total and free testosterone levels are lower in metabolic acidosis and total and free testosterone levels were positively associated with HCO3 level.

Testosterone Deficiency and Nutritional Parameters as Predictors of All-Cause Mortality among Male Dialysis Patients

“…In the single Polish publication concerning the relationship between testosterone and prognosis in patients with CKD, Niemczyk et al implied that serum free testosterone concentration might be a better predictor of survival than age [ 17 ]. Likewise, in the presented study, FT, with a cut-off value of 54.6 pg/mL determined on the basis of the ROC curve, was the best prognostic parameter among all androgens in male hemodialysis patients.…”

“…Hypogonadism is a group of clinical symptoms resulting from testosterone deficiency (low concentrations of total/free testosterone) explained by multifactorial causes [ 9 , 10 ]. Testosterone deficiency in men is associated not only with sexual dysfunction but also with an unfavorable cardiometabolic profile, both in the general population [ 11 , 12 , 13 ] and patients with chronic kidney disease [ 14 , 15 , 16 , 17 , 18 ].…”

The association between serum testosterone and mortality among elderly men on hemodialysis

“…Testosterone therapy in men with hypogonadism might produce lean muscle mass gain, increased muscle strength and size, as well as weight loss . Hence, testosterone levels were correlated and associated with skeletal muscle mass and low testosterone concentrations might predict long‐term survival in those with CKD or dialysis …”

“…18,19 Hence, testosterone levels were correlated and associated with skeletal muscle mass and low testosterone concentrations might predict long-term survival in those with CKD or dialysis. 20,21 The aim of this study was to evaluate prognostic importance of serum testosterone in elderly men with hemodialysis and whether low testosterone levels were superior to low skeletal muscle mass in predicting mortality or not. As testosterone level predicted mortality in male HD patients was largely dependent on age, 14 we restricted our study population to elderly men to minimize the confounding effect of age and analyzed multiple risk factors and comorbid conditions at start of dialysis, including skeletal muscle mass index (SMMI), serum testosterone, BMI, and well-known risk factors for mortality after dialysis in a regional hospital.…”

Beraprost Sodium, a Stable Analogue of PGI2, Inhibits the Renin-Angiotensin System in the Renal Tissues of Rats with Chronic Renal Failure

“…Evidence has suggested a correlation between CRF and low serum levels of 1, 25-dihydroxyvitamin D3 (calcitriol or 1, 25[OH]2D3) as well as the reactive metabolite of vitamin D3 due to a reduction in renal 1α-hydroxylase (CYP27B1) [3]. CRF shares a strong association with older age along with an age-induced decline in renal functions resulting from conditions including vascular disease, hypertension, hepatitis C (HCV) infection, and diabetes mellitus [4][5][6]. An investigation into mesenchymal stem cells as a potential therapy for kidney injuries revealed that when endstage kidney disease is reached, renal transplantation is regarded as the optimal therapeutic approach, but there are several limitations, including a lack of organ donors and immune reactions observed within the five-year posttransplantation period, and these limitations vary across different age groups [7,8].…”