Hypogonadism in Male HD Patients Linked to Poor ESA Response

Other risk factors include reduced muscle mass and lower levels of physical activity.
Other risk factors include reduced muscle mass and lower levels of physical activity.

Hyporesponsiveness to erythropoiesis-stimulating agents (ESAs), reduced muscle mass, and lower levels of physical activity are associated with a greater likelihood of hypogonadism in men undergoing hemodialysis (HD), investigators in Spain concluded.

Gabriella Cobo, PhD, of Hospital Severo Ochoa, Leganes, Madrid, and colleagues studied 57 male HD patients, none of whom was undergoing testosterone replacement therapy. The investigators assessed body composition using bioelectrical impedance and physical activity with the use of pedometers.

The cohort had a mean testosterone level of 321 ng/dL. Twenty men (35%) were hypogonadal, and they were older and had lower mean arterial blood pressure, higher interleukin-6 levels, lower lean body mass and higher fat body mass than the men who were not hypogonadal. The required dose of ESAs, normalized by weight and hemoglobin levels, was significantly higher in the hypogonadal than the men with normal testosterone levels (10.6 vs 4.0 UI/kg/mg/dL/week), Dr Cobo's group reported online in Nefrologia. The mean number of steps taken and lean body mass was significantly lower in the hypogonadal patients than those with normal testosterone levels (2753 vs 4291 steps/day and 45% vs 48%).

“Conceivably, these associations reflect inadequate erythropoiesis and low muscle protein synthesis due to low levels of circulating testosterone, while the observed link between low testosterone levels and physical inactivity is most likely explained by reduced muscle mass due to hypogonadism,” the authors wrote.

The results of the current study, they concluded, can be of value for raising awareness of hypogonadism in male patients with chronic kidney disease and increasing interest on the potential of treating testosterone deficiency.

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