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Kidney Week

Abstract: FR-PO250

Testosterone Replacement Therapy (TRT) Delays Early Progression of CKD in Diabetes Mellitus (DM2)

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Authors

  • Garcia-Touza, Mariana, Kansas City VA, Kansas City, Missouri, United States
  • Gupta, Aditi, University of Kansas Medical Center, Kansas City, Kansas, United States
  • Sharma, Mukut, KCVA Medical Center, Kansas City, Missouri, United States
  • Savin, Virginia J., KC VA Medical Center, Kansas City, Kansas, United States
  • Sharma, Ram, Kansas City VA Medical Center, Kansas City, Missouri, United States
  • Goel, Archana, Kansas City VA Medical Center, Kansas City, Missouri, United States
  • Wiegmann, Peter Sigurd, Midwest Biomedical Research Foundation, Kansas City, Missouri, United States
Background

We have previously shown that TRT provides significant survival benefits in hypogonadic men with kidney disease. Faster progression of chronic kidney disease (CKD) in DM2 is well known. Testosterone deficiency is common in both CKD and DM2. Here we examined if TRT slows CKD progression, cardiovascular disease and mortality in patients with DM2.

Methods

Data from a large cohort of veterans diagnosed with low total testosterone were used to determine the effect of TRT on the progression of CKD, cardiovascular diseases and all-cause mortality in patients with DM2. Increase in serum creatinine > 1.5 mg/dl was taken as a measure of progression of CKD. Data were extracted using the Veterans Administration Informatics and Computing Infrastructure (VINCI), and analyzed using SAS.. Propensity matching for age, followup time and prior vascular disease was used to adjust groups. Results were compared by means tests, frequency tables, odds ratio and p values (p=<0.01).

Results

Of 57,985 patients with testosterone deficiency, 14,496 with DM2 had treatment (DM2_TRT) and 4319 had none (DM2_No_TRT), compared to controls without DM2 (Ctrl_TRT, N=29,938, Ctrl_No_TRT, N=9,232). Baseline DM2 age was higher (58.3 vs 61.6 yr). Followup and creatinine were was similar (Ctrl vs DM2 : 6.0 vs 5.7 yrs ; 1.02 vs. 1.06 mg/dl). TRT provided significant reduction in all-cause mortality in both groups, (Odds DM2 0.69, 95% CI 0.65-0.74; Odds Ctrl 0.72, 95% CI 0.69-0.77). TRT reduced the progression of CKD (Odds DM2 0.71, 95% CI 0.67-0.75; Odds Ctrl 0.85, 95% CI 0.81-0.89). TRT reduced CVA (Odds DM2 0.86, 95% CI 0.76-0.98; Odds Ctrl 0.86, 95% CI 0.77-0.94). TRT reduced new MI in both groups (Odds DM2 0.74; Odds Ctrl 0.79). TRT reduced new retinopathy slightly. Prior cardiovascular disease was more common with DM2 (% difference Dx/Ctrl), e.g. CAD (158%), CHF (229%), CVA (89%), HTN (112%), MI (118%), PAD (185%).

Conclusion

TRT is associated with significant reductions in progression of early CKD[AG1] , all-cause mortality and new cardiovascular diagnoses in patients with DM2 even while DM2 is associated with increased prior cardiovascular disease.

Funding

  • Veterans Affairs Support