Oral Presentation The Annual Scientific Meeting of the Endocrine Society of Australia and the Society for Reproductive Biology 2014

Sex steroid levels in chronic kidney disease, dialysis and kidney transplant recipients (#199)

Mathis Grossmann 1 , Rudolf Hoermann 2 , Mark Ng Tang Fui 2 , Jeffrey Zajac 2 , Franscesco Ierino 3 , Matthew Roberts 4
  1. University of Melbourne, Austin Health, Heidelberg, VIC, Australia
  2. University of Melbourne Austin Health, Heidelberg, VIC, Australia
  3. Renal Unit, Austin Health , Heidelberg, VIC
  4. Renal Medicine, Eastern Health Clinical School, Monash University, Box Hill, VIC

Background: We hypothesized that levels of circulating sex steroids i) change with stages of chronic kidney disease (CKD) and ii) are associated with clinical outcomes.

Methods: We conducted a prospective observational study. 221 patients (143 males, 78 females) with CKD comprising 49 patients with CKD III-IV, 102 dialysis patients, and 70 kidney transplant recipients (KTR) were followed at a tertiary referral centre to death or kidney transplant. Baseline serum sex steroid levels were repeatedly measured by liquid chromatography/ tandem mass spectrometry.

Results: In males, but not in females, both testosterone (p=0.003) as well as estradiol (p<0.02) levels were lowest in dialysis patients and highest in KTR. Over a median follow up of 8.5 years (interquartile range 3.8-9.2), 52 men (36%) died, and 24 (17%) received a kidney transplant. In multivariate analyses using Cox proportional hazard models up to 9.6 years, testosterone predicted mortality independent of baseline age, body mass index, and renal disease status (p=0.02), and circulating levels of brain natriuretic peptides or cardiac troponin T (p<0.05). An increase in testosterone by 1 nmol/L was associated with a 9.8% (95% confidence interval 3.1-16.3%) decrease in mortality. By contrast, sex steroid levels were not associated with mortality in females.

Conclusions:             Low testosterone levels predict mortality in males, independent of established and novel predictors of mortality in CKD.