Kidney Week

Abstract: SA-PO1068

The Impact of Pre-ESRD Testosterone Level upon Post-ESRD Mortality Among US Male Veterans: A Transition of Care in CKD Study

Session Information

• Diet and Nutrition: Clinical
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Health Maintenance, Nutrition, and Metabolism

• 1302 Health Maintenance, Nutrition, and Metabolism: Clinical

Authors

• Hsiung, Jui-Ting, University of California, Irvine, Orange, California, United States

Jui-Ting Hsiung,

• Streja, Elani, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States

Elani Streja,

• You, Amy Seung, University of California, Irvine, Orange, California, United States

Amy Seung You,

• Potukuchi, Praveen Kumar, University of Tennessee Health Science Center, Memphis, Tennessee, United States

Praveen Kumar Potukuchi,

• Soohoo, Melissa, University of California at Irvine, Orange, California, United States

Melissa Soohoo,

• Nguyen, Danh V., University of California, Irvine, Orange, California, United States

Danh V. Nguyen,

• Amin, Alpesh, UC Irvine, Orange, California, United States

Alpesh Amin,

• Sim, John J., Kaiser Permanente Southern California, Los Angeles, California, United States

John J. Sim,

• Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States

Csaba P. Kovesdy,

• Kalantar-Zadeh, Kamyar, University of California Irvine, School of Medicine, Orange, California, United States

Kamyar Kalantar-Zadeh,

• Rhee, Connie, University of California Irvine, Huntington Beach, California, United States

Connie Rhee,

Background

Testosterone deficiency is a common endocrine complication in the elderly male population, with a disproportionately high prevalence observed in those with chronic kidney disease (CKD). While lower circulating levels of testosterone have been linked with higher risk of cardiovascular disease and death in the general population, little is known about the impact of testosterone deficiency upon the health and survival of non-dialysis dependent (NDD) CKD patients transitioning to end-stage renal disease (ESRD).

Methods

Among a national cohort of male US veterans with NDD-CKD transitioning to ESRD over 2007-15, we examined the association of total testosterone levels averaged over the two-year pre-ESRD prelude period with post-ESRD mortality risk using Cox models adjusted for sociodemographics, cause of ESRD, Charlson comorbidity score, and comorbidities.

Results

Among 1219 veterans who underwent one or more total testosterone measurements in the two-year prelude period, those in the lowest testosterone tertile had higher mortality risk in expanded case-mix models (ref: highest tertile): adjusted HR (aHR) (95%CI) 1.31 (1.07-1.62) (Figure). A similar relationship between the lowest total testosterone tertile and higher death risk was observed when measurements were examined over six-month and one-year prelude periods: aHRs (95%CI): 1.70 (1.16-2.49) and 1.46 (1.11-1.93), respectively.

Conclusion

In male US veterans transitioning to dialysis, lower total testosterone levels in the pre-ESRD prelude period were associated with higher post-ESRD mortality risk. Further studies are needed to determine the specific underlying pathways between testosterone deficiency and mortality in this population, and whether administration of testosterone replacement therapy in the pre-ESRD prelude period can improve post-ESRD outcomes.

Funding

• NIDDK Support