Testosterone Deficiency as One of the Major Endocrine Disorders in Chronic Kidney Disease

Abstract

Reduced testosterone concentration is nowadays thought to be one of the main endocrine disorders in chronic kidney disease (CKD). It is caused by the dysfunction of the hypothalamic-pituitary-gonadal axis. The role of testosterone is multifactorial. Testosterone is responsible not only for reproductive processes, but it is a hormone which increases bone and muscle mass, improves lipid profile, insulin sensitivity, erythropoiesis, reduces blood pressure, and ameliorates mood and perception. The implications of hypogonadism in CKD are infertility and loss of libido, reduction of muscle mass and strength, disorders in bone mineralization, the development of sarcopenia and protein energy wasting (PEW), progression of atherosclerosis, increased visceral adiposity, insulin resistance, and anaemia. Reduced testosterone serum concentrations in CKD are associated with increased mortality rate. Testosterone supplementation improves sexual functions, reduces the level of inflammatory markers and blood pressure, stimulates muscle protein synthesis, improves insulin sensitivity and lipid profile, and increases muscle mass, bone mineral density, and haemoglobin concentration. It positively affects mood and well-being. The modes of testosterone supplementation are intramuscular injections, subcutaneous pellets, and percutaneous methods—patches and gels. Successful kidney transplantation may improve gonadal function and testosterone production, however, half of men with low testosterone concentrations before kidney transplantation do not restore hormonal function.

The association between testosterone deficiency and nocturia: Insights from The National Health and Nutrition Examination Survey data set

“…Testosterone acts on cardiomyocyte testosterone receptors, potentially making individuals with TD more susceptible to heart failure. 22 In addition, TD is believed to be associated with arrhythmia and myocardial perfusion. CVD, including hypertension, can cause sodium retention and compensatory nocturnal sodium excretion, leading to fluid accumulation during the daytime and subsequent nocturia.…”

“…Another mechanism involves the close relationship between TD and CVD. Testosterone acts on cardiomyocyte testosterone receptors, potentially making individuals with TD more susceptible to heart failure 22 …”

Nutrition Management in Geriatric Patients with CKD

“… 48 Low serum levels of testosterone in CKD are associated with exaggerated sarcopenia and PEW, as well as increased mortality. 49 , 50 According to the British Society for Sexual Medicine guidelines, testosterone therapy is indicated in men with symptoms of hypogonadism and total serum testosterone concentration <8 nmol/L or free testosterone <180 pmol/L. 51 The aims of testosterone supplementation in CKD include improvement of quality of life, muscle mass, and functional status.…”

Melatonin Treatment in Kidney Diseases

“…It affects almost 13% of the world population [ 65 ]. CKD is associated with many complications, such as malnutrition; anemia; hyperlipidemia; overhydration; and endocrine, mineral bone, and metabolic disorders [ 65 , 66 , 67 ]. Patients with CKD, especially those who are treated with renal replacement therapy, frequently suffer from sleep disturbances [ 68 ].…”