School of Medical Sciences, Örebro University, Örebro, Sweden.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden.
Nephrol Dial Transplant. 2023 May 31;38(6):1519-1527. doi: 10.1093/ndt/gfac278.
Hypogonadism is common in end-stage kidney disease and may contribute to morbidity and mortality.
Using data from the randomized controlled Evaluation of Cinacalcet Therapy to Lower Cardiovascular Events (EVOLVE) trial of cinacalcet, we analyzed the associations of total testosterone, free testosterone and sex hormone-binding globulin (SHBG) serum concentrations with mortality and major cardiovascular events in 1692 men and 1059 women receiving hemodialysis. We also describe the effect of cinacalcet treatment on serum concentrations of testosterone.
Among men, lower serum free testosterone [odds ratio (OR) 0.18, 95% confidence interval (CI) 0.04-0.82, P = .026] and higher SHBG (OR 1.05 per 10 nmol/L, 95% CI 1.01-1.10, P = .012), but not total testosterone, were associated with higher risk of death or cardiovascular event. Only SHBG was associated with all-cause mortality (OR 1.07 per 10 nmol/L, 95% CI 1.02-1.12, P = .0073). Among women, neither total nor free testosterone, nor SHBG were associated with outcomes. We found no statistically significant effect of cinacalcet treatment on SHBG, free or total testosterone.
Lower free testosterone and higher SHBG in serum are associated with higher risk of death or cardiovascular event in men undergoing chronic hemodialysis.
性腺功能减退症在终末期肾病中很常见，可能导致发病率和死亡率升高。
利用依降钙素治疗降低心血管事件的随机对照评估（EVOLVE）试验中依降钙素的数据，我们分析了 1692 名男性和 1059 名接受血液透析的女性患者的总睾酮、游离睾酮和性激素结合球蛋白（SHBG）血清浓度与死亡率和主要心血管事件的关系。我们还描述了依降钙素治疗对睾酮血清浓度的影响。
在男性中，较低的游离睾酮血清浓度[比值比（OR）0.18，95%置信区间（CI）0.04-0.82，P=0.026]和较高的 SHBG（每增加 10 nmol/L 的 OR 1.05，95%CI 1.01-1.10，P=0.012）与死亡或心血管事件风险增加相关，但总睾酮与死亡或心血管事件风险无关。只有 SHBG 与全因死亡率相关（每增加 10 nmol/L 的 OR 1.07，95%CI 1.02-1.12，P=0.0073）。在女性中，总睾酮、游离睾酮和 SHBG 与结局均无关。我们发现依降钙素治疗对 SHBG、游离或总睾酮没有统计学上的显著影响。
在接受慢性血液透析的男性中，血清中游离睾酮降低和 SHBG 升高与死亡或心血管事件风险增加相关。
