Association between Testosterone and Mortality Risk among U.S. Males Receiving Dialysis.
Association between Testosterone and Mortality Risk among U.S. Males Receiving Dialysis.
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接受透析的美国男性睾酮与死亡风险之间的关联。
DOI：
10.1159/000480302
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发表时间：
2017
影响因子：
4.2
通讯作者：
Rhee,ConnieM
中科院分区：
文献类型：
--
作者：
Yu,Jerry;Ravel,VanessaA;You,AmyS;Streja,Elani;Rivara,MatthewB;Potukuchi,PraveenK;Brunelli,StevenM;Kovesdy,CsabaP;Kalantar-Zadeh,Kamyar;Rhee,ConnieM
背景：在一般人群中，低循环睾酮水平与心血管疾病和死亡的高风险相关。虽然睾酮缺乏在透析患者中很常见，但睾酮和死亡率的研究在这一人群中是模糊和重叠的。我们假设较低的睾酮水平与男性透析患者较高的死亡率有关。方法：我们检查了一个具有全国代表性的男性透析患者队列，这些患者来自美国一家大型透析组织，在2007年1月至2011年12月期间接受了一次或多次总睾酮测量。使用Cox模型对扩展病例组合和实验室协变量进行调整，研究四分位数分类的总睾酮与全因死亡率之间的关系。我们还使用限制性三次样条检验了总睾酮作为全因死亡率的连续预测因子。结果：624例男性透析患者中，51%的患者表现为睾酮缺乏（总睾酮<300 ng/dL）；中位（IQR）总睾酮水平为297 (190-424)ng/mL。在扩展病例组合+实验室校正Cox分析中，我们观察到低睾酮水平与高死亡风险之间存在分级关联（参考：四分位数3）：四分位数1、2和4的校正风险比（95% CI）分别为2.32（1.33-4.06）、1.80（0.99-3.28）和0.68（0.32-1.42）。在调整样条分析中，睾酮水平越高，睾酮水平越低-死亡率风险越高的相关性越低，直到达到400 ng/dL的阈值，超过该阈值，风险趋于稳定。结论：低睾酮水平与男性透析患者较高的死亡风险独立相关。需要进一步的研究来确定潜在的机制，以及睾酮替代是否能改善这一人群的死亡风险。
Background:Among the general population, low circulating testosterone levels are associated with higher risk of cardiovascular disease and death. While testosterone deficiency is common in dialysis patients, studies of testosterone and mortality in this population are ambiguous and overlapping. We hypothesized that lower testosterone levels are associated with higher mortality in male dialysis patients.Methods:We examined a nationally representative cohort of male dialysis patients from a large US dialysis organization who underwent one or more total testosterone measurements from 1/2007 to 12/2011. The association between total testosterone categorized as quartiles and all-cause mortality was studied using Cox models adjusted for expanded case-mix and laboratory covariates. We also examined total testosterone as a continuous predictor of all-cause mortality using restricted cubic splines.Results:Among 624 male dialysis patients, 51% of patients demonstrated testosterone deficiency (total testosterone <300 ng/dL); median (IQR) total testosterone levels were 297 (190-424) ng/mL. In expanded case-mix + laboratory adjusted Cox analyses, we observed a graded association between lower testosterone levels and higher mortality risk (ref: quartile 3): adjusted hazard ratios (95% CI) 2.32 (1.33-4.06), 1.80 (0.99-3.28), and 0.68 (0.32-1.42) for Quartiles 1, 2, and 4, respectively. In adjusted spline analyses, the lower testosterone-higher mortality risk association declined with higher testosterone levels until the value reached a threshold of 400 ng/dL above which risk plateaued.Conclusion:Lower testosterone levels were independently associated with higher mortality risk in male dialysis patients. Further studies are needed to determine underlying mechanisms, and whether testosterone replacement ameliorates death risk in this population.