Hypogonadism Ups Death Risk in Men on Hemodialysis

Canadian researchers found a high prevalence of hypogonadism among men on hemodialysis (HD), and this was associated with an increased risk of death, according to a new report.

The study included 623 men on HD who were enrolled in the prospective Canadian Kidney Disease Cohort Study. Of these, 343 (55%) had low testosterone (below 231 ng/dL). hypogonadism, defined as Compared with men who had normal testosterone levels (above 246 ng/dL), those who had low levels had a significant 48% increased risk of all-cause mortality, after adjusting for potential confounders, investigators reported online ahead of print in the American Journal of Kidney Diseases.

The adjusted risk of all-cause mortality varied by age, the study showed. Among men younger than 63 years, those with low testosterone had a significant 2.9 times increased risk compared with men who had normal testosterone levels. The researchers, led by Marcello Tonelli, MD, of the University of Alberta in Edmonton, found no significant effect of testosterone level on mortality risk among men aged 63 years or older.

Additionally, men with low testosterone had significant lower Health Utility Index scores than those with normal testosterone levels, indicating a poorer health-related quality of life. Although the study demonstrated a significant trend in the unadjusted risk of cardiovascular events, this risk did not persist in adjusted analyses.

“To our knowledge, this is the largest study investigating the association between serum testosterone levels and adverse outcomes in a prospective cohort of HD patients,” the authors wrote.

The researchers defined hypogonadism using criteria established by the International Society of Andrology, International Society for the Study of the Aging Male, and the European Association of Urology.

The finding that low testosterone may contribute to excess all-cause mortality and low quality of life in men on HD “raises the hypothesis that hypogonadism may be a novel and modifiable risk factor for adverse clinical outcomes and poor quality of life in this patient group—a hypothesis that should be tested in randomize clinical trials,” the authors wrote.

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