SEATTLE—Low testosterone levels are independently associated with higher mortality risk in male dialysis patients, based on study findings presented at the 2016 Annual Dialysis Conference.
The retrospective cohort study included 624 patients receiving in-center peritoneal dialysis. At baseline, the cohort had a mean total testosterone level of 323 ng/dL. The first authors, Jerry Yu, MD, and Vanessa Ravel, MPH, both from the University of California Irvine School of Medicine, and colleagues divided patients into quartiles of testosterone levels. Over a median follow-up of 1.2 years, 108 deaths occurred. Men in the lowest testosterone quartile had a 2.8-fold higher risk of death compared with those in the third quartile, even after accounting for differences in sociodemographic, comorbidity, and selected laboratory characteristics, according to senior investigator Connie M. Rhee, MD, MSc, also from UC Irvine, who presented study results on behalf of the research team. Testosterone levels above 300 ng/dL were associated with optimal survival.
The study also found that congestive heart failure, higher body mass index, and higher ferritin levels were associated with a higher risk of testosterone deficiency, whereas black race was associated with a lower likelihood of having low testosterone levels, Dr. Rhee shared with attendees.
Dr. Rhee highlighted that the study strengths included its examination of a large nationally representative cohort of U.S. dialysis patients with an extended follow-up period, comprehensive availability of detailed patient-level data, and the performance of laboratory tests by a single center. With regards to future directions, the investigators have indicated the need for studies defining the underlying mechanisms of the testosterone-mortality association, as well as rigorous investigations of testosterone supplementation in the male dialysis population.