Testosterone deficiency is a cause of anaemia and reduced responsiveness to erythropoiesis-stimulating agents in men with chronic kidney disease

Hypogonadism or testosterone deficiency is a prevalent condition in men with chronic kidney disease (CKD). Testosterone stimulates erythropoiesis via production of haematopoietic growth factors and possible improvement of iron bioavailability. We hypothesized that testosterone deficiency predisposes...

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Published in:	Nephrology, dialysis, transplantation Vol. 27; no. 2; pp. 709 - 715
Main Authors:	CARRERO, Juan Jesus, BARANY, Peter, ILKER YILMAZ, Mahmut, RASHID QURESHI, Abdul, SONMEZ, Alper, HEIMBÜRGER, Olof, OZGURTAS, Tanez, YENICESU, Mujdat, LINDHOLM, Bengt, STENVINKEL, Peter
Format:	Journal Article
Language:	English
Published:	Oxford Oxford University Press 01-02-2012
Subjects:	Aged Analysis of Variance Anemia - drug therapy Anemia - etiology Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Blood. Blood coagulation. Reticuloendothelial system Cohort Studies Confidence Intervals Emergency and intensive care: renal failure. Dialysis management Glomerular Filtration Rate Hematinics - adverse effects Hematinics - therapeutic use Hemoglobins - analysis Hemoglobins - drug effects Humans Hypogonadism - complications Hypogonadism - diagnosis Hypogonadism - drug therapy Intensive care medicine Kidney Failure, Chronic - complications Kidney Failure, Chronic - diagnosis Kidney Failure, Chronic - therapy Kidney Function Tests Linear Models Male Medical sciences Medicin och hälsovetenskap Middle Aged Multivariate Analysis Odds Ratio Pharmacology. Drug treatments Renal Dialysis Retrospective Studies Risk Assessment Severity of Illness Index Testosterone - administration & dosage Testosterone - deficiency Treatment Outcome Erythropoiesis Human Kidney disease chronic kidney disease Urinary system disease Androgen Erythropoietin androgens sex hormones Hemodialysis Deficiency Extrarenal dialysis Testosterone Polypeptide Renal failure
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Summary:	Hypogonadism or testosterone deficiency is a prevalent condition in men with chronic kidney disease (CKD). Testosterone stimulates erythropoiesis via production of haematopoietic growth factors and possible improvement of iron bioavailability. We hypothesized that testosterone deficiency predisposes to anaemia and reduced responsiveness to erythropoiesis-stimulating agents (ESAs) in CKD men. Materials and methods. We studied associations between endogenous testosterone and haemoglobin in 239 ESA-naïve nondialysed CKD Stages 1-5 male patients. Additionally, we studied associations between endogenous testosterone levels and ESA dose (U/kg/week) in 126 ESA-treated men undergoing haemodialysis (HD). Among ESA-naïve males, patients with anaemia presented lower testosterone values. Endogenous testosterone was negatively associated with haemoglobin levels in uni- and multivariate models. Testosterone-deficient patients (total testosterone <10 nmol/L) were 5.3 (95% confidence interval 2.2-12.5) times more likely to be anaemic (Hb < 13.0 g/dL) than testosterone-sufficient patients. In ESA-treated men undergoing HD, higher ESA doses (above the median value of 121 IU/kg body weight/week) are associated with lower testosterone levels and higher percentage of hypochromic red blood cells (RBC). The inverse association between testosterone levels and ESA doses persisted after multivariate adjustment for age, sex hormone-binding globulin, comorbidities, C-reactive protein and s-albumin but was lost after further adjustment for iron medication and hypochromic RBC. Hypogonadism may be an additional cause of anaemia and reduced ESA responsiveness in men with CKD. Our results raise the possibility that restoration of testosterone levels in hypogonadal CKD males may translate into lower prevalence of anaemia and better ESA responsiveness.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0931-0509 1460-2385 1460-2385
DOI:	10.1093/ndt/gfr288