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Abstract: TH-PO656

The Effects of Testosterone Replacement Therapy (TRT) in Patients Established Dementia

Session Information

  • Geriatric Nephrology
    November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Geriatric Nephrology

  • 1100 Geriatric Nephrology

Authors

  • Gupta, Aditi, University of Kansas Medical Center, Kansas City, Kansas, United States
  • Garcia-Touza, Mariana, Kansas City VA, Kansas City, Missouri, 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, VA Medical Center, Kansas City, Kansas, United States
  • Wiegmann, Thomas, VA Medical Center, Kansas City, Kansas, United States
Background

Testosterone deficiency is common in both chronic kidney disease (CKD) and dementia. We have previously shown that dementia is associated with a faster progression of CKD, increased vascular disease and mortality. Here we examined the effect of TRT in patients with dementia and testosterone deficiency on progression of CKD progression, vascular disease and mortality.

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 progression of CKD, cardiovascular events and all cause mortality in patients with dementia. Increase in serum creatinine to >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 was used to adjust for age, vascular disease and follow up time. Results were compared using means tests, frequency tables, and odds ratios. P values ≤0.01 were considered significant.

Results

Of the 1,792 patients with dementia, 1,317 received TRT. Of the 57,985 controls without dementia, 44,434 received TRT. Baseline creatinine was similar in the dementia and control groups (1.06 mg/dl). TRT slowed the progression of CKD in patients with dementia (OR 0.63, 95% CI 0.51-0.79) and in controls (OR 0.89, 95% CI 0.88-0.91), and decreased all-cause mortality in patients with dementia (OR 0.61, 95% CI 0.49-0.75) and in controls (OR 0.85, 95% CI 0.84-0.87). TRT also decreased incident cerebrovascular accident (CVA) in dementia (OR 0.57,95% CI 0.41-0.79) and controls (OR 0.88, 95% CI 0.81-0.95), but incident myocardial infarction (MI) was decreased in controls only (OR 0.76, 95% CI 0.67-0.85). TRT did not reduce new diagnosis of retinopathy or nephropathy. Prior cardiovascular disease was more common in patients with dementia (% difference dementia/control), coronary artery disease (117), congestive heart failure (92), CVA (496), hypertension (67), MI (140), peripheral artery disease (129). Average follow up was 6.1 years.

Conclusion

TRT decreases the progression of CKD, CVA and all-cause mortality in patients with dementia. This finding is important, as dementia is associated with increased CKD progression, vascular disease and mortality.

Funding

  • Other NIH Support