Advanced Chronic Kidney Disease is a Strong Predictor of Hypogonadism and is Associated with Decreased Lean Tissue Mass

Figures & data

Figure 1 Comparison of total testosterone (left) and free testosterone (right) concentrations according to CKD stage.

Abbreviation: GFR, glomerular filtration rate (mL/min/1.73 m²).

Figure 2 Initial (A) and optimal (B) risk categories of hypogonadism based on CKD stage in the study group (men ≥40 years).

Abbreviations: IV, information value; WOE, weight of evidence (WoE technique).

Table 1 Characteristics of the Advanced CKD and the Control Group

Parameter	Advanced CKD Group (n=52)	Control Group (n=60)	p-Value
Demographic data
Age [years]	61 [53–67]	61 [55–67]	0.464*
Diabetes
Yes	25	18	0.078^
No	25	37
Data missing	2	5
Anthropometric measurements
Height [cm]	174±5	174±6	0.793
Weight [kg]	90±17	92±16	0.434
BMI [kg/m^Citation2]	29.5±5.5	30.4±4.8	0.392
Hormonal status
Hypogonadism
With low LH (CH)	0	1 (6.25%)	0.031
With normal LH (iPH)	12 (33.3%)	10 (62.5%)
With high LH (PH)	24 (66.7%)	5 (31.25%)
No hypogonadism
With normal LH (EuG)	3 (18.75%)	33 (75%)	<0.0001
With high LH (cPH)	13 (81.25%)	11 (25%)
Erectile dysfunction
IIEF-5 score	10 (3–16)	15 (10–20)	0.017*
Biochemical measurements
Serum creatinine [mg/dL]	6.5 [4.3–9.2]	1.2 [0.9–0.7]	<0.0001*
eGFR [mL/min/1.73 m^2]	9.6 [6.1–15.5]	66.7 [45.1–91.8]	<0.0001*
Serum albumin [g/dL]	4.2±0.5	4.4±0.4	0.017
Prealbumin [mg/dL]	36 [29–39]	29 [23–35]	0.011*
Total cholesterol [mg/dL]	153 [124–189]	181 [145–209]	0.013*
HDL	42 [35–46]	43 [40–52.5]	0.068*
LDL	84 [61–113]	107 [86.5–142]	0.002*
Triglycerides [mg/dL]	171 [111–199]	141 [104–199]	0.397*
C-reactive protein [mg/dL]	0.4 [0.2–0.7]	0.2 [0.1–0.4]	0.008*
SHBG [nmol/L]	44.8 [31.1–58]	44 [32.9–54.7]	0.76*
Hormonal measurements
Total testosterone [ng/mL]	3.05±1.15	3.98±1.48	0.036#
Free testosterone [pg/mL]	48.4±18.5	64.8±17.9	<0.0001
Prolactin [ng/mL]	17.7 [13.6–26.2]	9.6 [8.2–12.2]	<0.0001*
LH [IU/L]	10.1 [8.5–15.5]	6.5 [4.5–8.9]	<0.0001*
Bioimpedance spectroscopy
LTM [kg]	43±9.3	48±9.8	0.009
LTM% [%]	49.1±12.4	53.4±12.7	0.086
LTI [kg/m^Citation2]	14.1±2.9	15.7±2.6	0.004
LTI_dif from ref [kg/m^Citation2]	−0.3±2.6	1.7±2.3	<0.0001
BCM [kg]	23.8±6.5	27.4±6.6	0.006
ATM [kg]	44±16.9	42.8±16.5	0.719
Fat [kg]	32.3±12.4	31.4±12.1	0.717
Fat% [%]	34.9±9.4	33.4±9.1	0.406
FTI [kg/m^Citation2]	14.5±5.6	14.1±5.4	0.725
FTI_dif from ref [kg/m^Citation2]	9.2±5.6	8.2±5.3	0.325
TBW [L]	42.5±6.3	44±6.1	0.228
ECW [L]	20.8±3.2	20.3±2.8	0.372
ICW [L]	21.7±3.8	23.7±3.8	0.009
OH [L]	1.9 [0.6–3.3]	0.5 [−0.7 to 1]	<0.0001*

Notes: *p-value of Mann–Whitney test; ^p-value of Fisher’s exact test; #p-value of unequal variance t-test; p-values in bold are statistically significant.

Abbreviations: ATM, adipose tissue mass; BCM, body cell mass; BMI, body mass index; CH, central hypogonadism; cPH, compensated primary hypogonadism; dif from ref, difference from reference; ECW, extracellular water; eGFR, estimated glomerular filtration rate; EuG, eugonadal; FTI, fat tissue index; HDL, high-density lipoprotein; ICW, intracellular water; IIEF-5, International Index of Erectile Function; iPH, primary hypogonadism with inadequate LH response; LDL, low-density lipoprotein; LH, luteinizing hormone; LTI, lean tissue index; LTM, lean tissue mass; OH, overhydration; PH, primary hypogonadism; TBW, total body water.

Table 2 Univariate Logistic Regression Models Evaluating Independent Markers of Hypogonadism in the Study Population

Variable	Level of Effect	Coefficient±SE	OR (95% CI)	p-Value	R^2
eGFR	GFR ≥30	Ref		–	0.23
	GFR <30	1.82±0.42	6.19 (2.72–14.06)	<0.0001
Diabetes	No	Ref		–	0.04
	Yes	3.44±0.06	0.47 (0.21–1.04)	0.064
Age		0.01±0.02	1.01 (0.96–1.05)	0.788	0
SA		−0.29±0.36	0.75 (0.37–1.51)	0.421	0.01
SHBG		−0.02±0.009	0.98 (0.96–0.997)	0.024	0.09
BMI		0.04±0.04	1.04 (0.97–1.12)	0.287	0.01
LTI		−0.21±0.08	0.81 (0.69–0.94)	0.006	0.11
LTI dif from ref		−0.31±0.09	0.74 (0.61–0.88)	0.001	0.16
LTM		−0.05±0.02	0.95 (0.91–0.99)	0.018	0.08
LTM%		−0.05±0.02	0.95 (0.92–0.98)	0.004	0.12

Note: p-Values in bold are statistically significant.

Abbreviations: BMI, body mass index; CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; LTI, lean tissue index; LTM, lean tissue mass; SA, serum albumin; SHBG, sex hormone binding globulin.; diffrom ref, difference from reference.

Hall SA, Esche GR, Araujo AB, et al. Correlates of low testosterone and symptomatic androgen deficiency in a population-based sample. J Clin Endocrinol Metab. 2008;93(10):3870‐3877. doi:10.1210/jc.2008-0021.

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