van der Burgh Anna C, Aribas Elif, Ikram M Arfan, Kavousi Maryam, Neggers Sebastian J C M M, Hoorn Ewout J, Chaker Layal
Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands.
Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
Kidney Int Rep. 2023 Apr 24;8(7):1342-1351. doi: 10.1016/j.ekir.2023.04.015. eCollection 2023 Jul.
Testosterone might prevent kidney function decline, although evidence is limited in men and lacking in women from the general population. We investigated the association between serum testosterone and kidney function in men and women from a large population-based cohort study.
Participants aged ≥45 years with available measurements of serum testosterone, sex hormone-binding globulin (SHBG), creatinine, and cystatine C were included. Assessments of kidney function included baseline assessments of the estimated glomerular filtration rate (eGFR) based on serum creatinine (eGFRcreat) or serum cystatin C (eGFRcys), and the urine albumin-to-creatinine ratio (ACR), and repeated assessments of eGFRcreat. Linear regression and linear mixed models were used to assess the associations of serum free and total testosterone with kidney function, stratified for sex.
A total of 4095 men and 5389 women (mean age 65.2 years) were included. In men, higher free testosterone was associated with lower eGFRcreat (beta -0.63, 95% confidence interval [CI]: -1.05; -0.21), higher eGFRcys (beta 0.56, 95% CI: 0.07; 1.05), and lower ACR (beta -0.25, 95% CI: -0.35; -0.16) at baseline. Higher total testosterone was associated with higher baseline and follow-up eGFRcreat, and with lower eGFRcreat when additionally adjusted for SHBG. In women, higher free testosterone was associated with lower baseline eGFRcreat and eGFRcys (beta -1.03, 95% CI: -1.36; -0.71; beta -1.07, 95% CI: -1.44; -0.70; respectively) and lower eGFRcreat over time (beta -0.78, 95% CI: -1.10; -0.46), but not with ACR.
eGFRcys might be a better parameter than eGFRcreat for the association of testosterone with kidney function, although further studies investigating this are needed. Furthermore, we identified sex differences in the association between testosterone and kidney function, with a positive association in men and a negative association in women.
睾酮可能会预防肾功能衰退，不过在普通人群中，针对男性的相关证据有限，针对女性则缺乏此类证据。我们在一项大型基于人群的队列研究中，调查了男性和女性血清睾酮与肾功能之间的关联。
纳入年龄≥45岁且有血清睾酮、性激素结合球蛋白（SHBG）、肌酐和胱抑素C测量值的参与者。肾功能评估包括基于血清肌酐（eGFRcreat）或血清胱抑素C（eGFRcys）的估计肾小球滤过率（eGFR）的基线评估，以及尿白蛋白与肌酐比值（ACR），并对eGFRcreat进行重复评估。使用线性回归和线性混合模型来评估血清游离睾酮和总睾酮与肾功能的关联，并按性别分层。
共纳入4095名男性和5389名女性（平均年龄65.2岁）。在男性中，较高的游离睾酮与基线时较低的eGFRcreat（β -0.63，95%置信区间[CI]：-1.05；-0.21）、较高的eGFRcys（β 0.56，95% CI：0.07；1.05）和较低的ACR（β -0.25，95% CI：-0.35；-0.16）相关。较高的总睾酮与较高的基线和随访eGFRcreat相关，在额外调整SHBG后与较低的eGFRcreat相关。在女性中，较高的游离睾酮与较低的基线eGFRcreat和eGFRcys（分别为β -1.03，95% CI：-1.36；-0.71；β -1.07，95% CI：-1.44；-0.70）以及随时间推移较低的eGFRcreat（β -0.78，95% CI：-1.10；-0.46）相关，但与ACR无关。
对于睾酮与肾功能的关联，eGFRcys可能是比eGFRcreat更好的参数，不过仍需要进一步研究来证实。此外，我们发现睾酮与肾功能之间的关联存在性别差异，在男性中为正相关，在女性中为负相关。
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