Skiba Ryszard, Matyjek Anna, Syryło Tomasz, Niemczyk Stanisław, Rymarz Aleksandra
Department of General, Functional and Oncological Urology, Military Institute of Medicine, Warsaw, Poland.
Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, Warsaw, Poland.
Int J Nephrol Renovasc Dis. 2020 Nov 5;13:319-327. doi: 10.2147/IJNRD.S275554. eCollection 2020.
In patients with chronic kidney disease (CKD), hypogonadism is more frequent than in the general population and its prevalence ranges between 40% and 60%. The aim of the study was to investigate the prevalence of hypogonadism and its association with kidney function, body composition, inflammatory markers and lipid disorders in patients with CKD.
The study population consisted of 112 men aged ≥40 years in different stages of CKD: 33 participants with eGFR ≥60 mL/min/1.73 m, 27 men with eGFR 30-59 mL/min/1.73 m, 17 predialysis patients with eGFR <30 mL/min/1.73 m, and 35 men on hemodialysis therapy three times a week for more than 3 months (G5D stage). Total testosterone (TT) levels were measured and free testosterone (FT) levels were calculated. Body composition was assessed using bioimpedance spectroscopy (Body Composition Monitor, FMC). Statistical analysis was performed using Statistica version 13.1.
CKD stage was a strong predictor of hypogonadism (providing an information value of 0.83). The weight of evidence technique allowed us to differentiate the high-risk group, which was a group of patients with advanced CKD, defined as eGFR <30 mL/min/1.73 m. In this group, the likelihood of hypogonadism was 69.23%. Another significant predictor of hypogonadism was lean tissue index (LTI). TT and FT levels were significantly lower in the advanced CKD group in comparison to the control group, whereas prolactin, luteinizing hormone and C-reactive protein levels were significantly higher in the advanced CKD group. The LTI was significantly lower in advanced CKD and was positively correlated with TT and FT.
Decreased eGFR and decreased LTI are predictors of hypogonadism associated with CKD. The study results suggest that hypogonadism screening should be carried out when eGFR deceases below 30 mL/min/1.73 m.
在慢性肾脏病（CKD）患者中，性腺功能减退比普通人群更为常见，其患病率在40%至60%之间。本研究的目的是调查CKD患者中性腺功能减退的患病率及其与肾功能、身体成分、炎症标志物和脂质紊乱的关系。
研究人群包括112名年龄≥40岁处于不同CKD阶段的男性：33名估算肾小球滤过率（eGFR）≥60 mL/min/1.73 m²的参与者，27名eGFR为30 - 59 mL/min/1.73 m²的男性，17名eGFR <30 mL/min/1.73 m²的透析前患者，以及35名每周进行三次血液透析治疗超过3个月的男性（G5D期）。测量总睾酮（TT）水平并计算游离睾酮（FT）水平。使用生物电阻抗光谱法（人体成分监测仪，FMC）评估身体成分。使用Statistica 13.1版进行统计分析。
CKD分期是性腺功能减退的有力预测指标（信息值为0.83）。证据权重技术使我们能够区分高危组，即晚期CKD患者组，定义为eGFR <30 mL/min/1.73 m²。在该组中，性腺功能减退的可能性为69.23%。性腺功能减退的另一个重要预测指标是瘦组织指数（LTI）。与对照组相比，晚期CKD组的TT和FT水平显著降低，而晚期CKD组的催乳素、促黄体生成素和C反应蛋白水平显著升高。晚期CKD患者的LTI显著降低，且与TT和FT呈正相关。
eGFR降低和LTI降低是与CKD相关的性腺功能减退的预测指标。研究结果表明，当eGFR降至低于30 mL/min/1.73 m²时应进行性腺功能减退筛查。
