Association between testosterone and mortality risk among U.S. Males Receiving Dialysis

Jerry Yu, Vanessa A. Ravel, Amy S. You, Elani Streja, Matthew B. Rivara, Praveen K. Potukuchi, Steven M. Brunelli, Csaba Kovesdy, Kamyar Kalantar-Zadeh, Connie M. Rhee

Research output: Contribution to journalArticle

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Abstract

Background: Among the general population, low circulating testosterone levels are associated with higher risk of cardiovascular disease and death. While testosterone deficiency is common in dialysis patients, studies of testosterone and mortality in this population are ambiguous and overlapping. We hypothesized that lower testosterone levels are associated with higher mortality in male dialysis patients. Methods: We examined a nationally representative cohort of male dialysis patients from a large US dialysis organization who underwent one or more total testosterone measurements from 1/2007 to 12/2011. The association between total testosterone categorized as quartiles and all-cause mortality was studied using Cox models adjusted for expanded case-mix and laboratory covariates. We also examined total testosterone as a continuous predictor of all-cause mortality using restricted cubic splines. Results: Among 624 male dialysis patients, 51% of patients demonstrated testosterone deficiency (total testosterone <300 ng/dL); median (IQR) total testosterone levels were 297 (190-424) ng/mL. In expanded case-mix + laboratory adjusted Cox analyses, we observed a graded association between lower testosterone levels and higher mortality risk (ref: quartile 3): adjusted hazard ratios (95% CI) 2.32 (1.33-4.06), 1.80 (0.99-3.28), and 0.68 (0.32-1.42) for Quartiles 1, 2, and 4, respectively. In adjusted spline analyses, the lower testosterone-higher mortality risk association declined with higher testosterone levels until the value reached a threshold of 400 ng/dL above which risk plateaued. Conclusion: Lower testosterone levels were independently associated with higher mortality risk in male dialysis patients. Further studies are needed to determine underlying mechanisms, and whether testosterone replacement ameliorates death risk in this population.

Original languageEnglish (US)
Pages (from-to)195-203
Number of pages9
JournalAmerican Journal of Nephrology
Volume46
Issue number3
DOIs
StatePublished - Sep 1 2017

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Testosterone
Dialysis
Mortality
Diagnosis-Related Groups
Population
Proportional Hazards Models
Cardiovascular Diseases
Organizations

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

Yu, J., Ravel, V. A., You, A. S., Streja, E., Rivara, M. B., Potukuchi, P. K., ... Rhee, C. M. (2017). Association between testosterone and mortality risk among U.S. Males Receiving Dialysis. American Journal of Nephrology, 46(3), 195-203. https://doi.org/10.1159/000480302

Association between testosterone and mortality risk among U.S. Males Receiving Dialysis. / Yu, Jerry; Ravel, Vanessa A.; You, Amy S.; Streja, Elani; Rivara, Matthew B.; Potukuchi, Praveen K.; Brunelli, Steven M.; Kovesdy, Csaba; Kalantar-Zadeh, Kamyar; Rhee, Connie M.

In: American Journal of Nephrology, Vol. 46, No. 3, 01.09.2017, p. 195-203.

Research output: Contribution to journalArticle

Yu, J, Ravel, VA, You, AS, Streja, E, Rivara, MB, Potukuchi, PK, Brunelli, SM, Kovesdy, C, Kalantar-Zadeh, K & Rhee, CM 2017, 'Association between testosterone and mortality risk among U.S. Males Receiving Dialysis', American Journal of Nephrology, vol. 46, no. 3, pp. 195-203. https://doi.org/10.1159/000480302
Yu, Jerry ; Ravel, Vanessa A. ; You, Amy S. ; Streja, Elani ; Rivara, Matthew B. ; Potukuchi, Praveen K. ; Brunelli, Steven M. ; Kovesdy, Csaba ; Kalantar-Zadeh, Kamyar ; Rhee, Connie M. / Association between testosterone and mortality risk among U.S. Males Receiving Dialysis. In: American Journal of Nephrology. 2017 ; Vol. 46, No. 3. pp. 195-203.
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AU - Rivara, Matthew B.

AU - Potukuchi, Praveen K.

AU - Brunelli, Steven M.

AU - Kovesdy, Csaba

AU - Kalantar-Zadeh, Kamyar

AU - Rhee, Connie M.

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N2 - Background: Among the general population, low circulating testosterone levels are associated with higher risk of cardiovascular disease and death. While testosterone deficiency is common in dialysis patients, studies of testosterone and mortality in this population are ambiguous and overlapping. We hypothesized that lower testosterone levels are associated with higher mortality in male dialysis patients. Methods: We examined a nationally representative cohort of male dialysis patients from a large US dialysis organization who underwent one or more total testosterone measurements from 1/2007 to 12/2011. The association between total testosterone categorized as quartiles and all-cause mortality was studied using Cox models adjusted for expanded case-mix and laboratory covariates. We also examined total testosterone as a continuous predictor of all-cause mortality using restricted cubic splines. Results: Among 624 male dialysis patients, 51% of patients demonstrated testosterone deficiency (total testosterone <300 ng/dL); median (IQR) total testosterone levels were 297 (190-424) ng/mL. In expanded case-mix + laboratory adjusted Cox analyses, we observed a graded association between lower testosterone levels and higher mortality risk (ref: quartile 3): adjusted hazard ratios (95% CI) 2.32 (1.33-4.06), 1.80 (0.99-3.28), and 0.68 (0.32-1.42) for Quartiles 1, 2, and 4, respectively. In adjusted spline analyses, the lower testosterone-higher mortality risk association declined with higher testosterone levels until the value reached a threshold of 400 ng/dL above which risk plateaued. Conclusion: Lower testosterone levels were independently associated with higher mortality risk in male dialysis patients. Further studies are needed to determine underlying mechanisms, and whether testosterone replacement ameliorates death risk in this population.

AB - Background: Among the general population, low circulating testosterone levels are associated with higher risk of cardiovascular disease and death. While testosterone deficiency is common in dialysis patients, studies of testosterone and mortality in this population are ambiguous and overlapping. We hypothesized that lower testosterone levels are associated with higher mortality in male dialysis patients. Methods: We examined a nationally representative cohort of male dialysis patients from a large US dialysis organization who underwent one or more total testosterone measurements from 1/2007 to 12/2011. The association between total testosterone categorized as quartiles and all-cause mortality was studied using Cox models adjusted for expanded case-mix and laboratory covariates. We also examined total testosterone as a continuous predictor of all-cause mortality using restricted cubic splines. Results: Among 624 male dialysis patients, 51% of patients demonstrated testosterone deficiency (total testosterone <300 ng/dL); median (IQR) total testosterone levels were 297 (190-424) ng/mL. In expanded case-mix + laboratory adjusted Cox analyses, we observed a graded association between lower testosterone levels and higher mortality risk (ref: quartile 3): adjusted hazard ratios (95% CI) 2.32 (1.33-4.06), 1.80 (0.99-3.28), and 0.68 (0.32-1.42) for Quartiles 1, 2, and 4, respectively. In adjusted spline analyses, the lower testosterone-higher mortality risk association declined with higher testosterone levels until the value reached a threshold of 400 ng/dL above which risk plateaued. Conclusion: Lower testosterone levels were independently associated with higher mortality risk in male dialysis patients. Further studies are needed to determine underlying mechanisms, and whether testosterone replacement ameliorates death risk in this population.

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