Abstract: SA-PO901
The Effects of Testosterone Replacement Therapy (TRT) in Patients' Established CKD
Session Information
- CKD: Pharmacoepidemiology
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Gupta, Aditi, University of Kansas Medical Center, Kansas City, Kansas, United States
- Wiegmann, Peter Sigurd, Midwest Biomedical Research Foundation, Kansas City, Missouri, United States
- Savin, Virginia J., KC VA Medical Center, Kansas City, Kansas, United States
- Sharma, Mukut, KCVA Medical Center, Kansas City, Missouri, United States
- Goel, Archana, KCVA Medical Center, Kansas City, Missouri, United States
- Garcia-Touza, Mariana, Kansas City VA, Kansas City, Missouri, United States
- Wiegmann, Thomas, VA Medical Center, Kansas City, Kansas, United States
Background
We have previously shown that TRT provides significant survival benefits and reduces CKD progression in hypogonadic men. Testosterone deficiency is common in CKD but the benefits of TRT are disputed. Here we examined if TRT slows CKD progression, cardiovascular disease and all cause mortality in patients with established CKD.
Methods
Data from a large cohort of veterans diagnosed with low total testosterone (n=57,985) were used to determine the effect of TRT on the CKD progression, cardiovascular diseases and all-cause mortality in patients with CKD. Data were extracted using the Veterans Administration Informatics and Computing Infrastructure (VINCI), and analyzed using SAS. Propensity score matching was used to adjust for age, vascular disease and follow up time. Results were compared by means tests, frequency tables, odds ratio and p values (p=<0.01).
Results
Of the 3,627 patients with CKD, 2,469 received TRT, and of the 54,358 controls without CKD 41,965 received TRT. Mean baseline serum creatinine was 1.97 mg/dl in CKD and 0.98 mg/dl in controls. TRT reduced new cardiovascular accident (CVA) in CKD (OR 0.86, 95% CI 0.76-0.98), and in controls (OR 0.86, 95% CI 0.77-0.94), and reduced all-cause mortality in CKD (OR 0.749, 95% CI 0.66-0.85) and controls (OR 0.71, 95% CI 0.68-0.74). New myocardial infarction (MI) in CKD were higher with TRT (OR 1.37) and lower in controls (OR 0.79). Prior cardiovascular disease was more common with CKD (% difference CKD/Control), coronary artery disease (130), congestive heart failure (284), CVA (111), hypertension (92), MI (162), peripheral artery disease (265). Average follow up was 6.1 years.
Conclusion
The protective effect of TRT on CKD progression in hypogonadic men appears to taper off in patients with established CKD. CKD is associated with a higher burden of cardiovascular disease. TRT reduces all-cause mortality in established CKD (and controls) but the beneficial effect on cardiovascular events is blunted in CKD, underscoring importance of early TRT.
Funding
- Other NIH Support