Men with chronic kidney disease (CKD) are often deficient in the hormone testosterone, and this contributes to frailty, fatigue, low sexual desire, and cognitive issues such as memory problems.
Previously, there have been concerns that the use of testosterone replacement therapy (TRT) might increase the risk of prostate cancer and cardiovascular problems in CKD patients.
Now an original study led by Dr Lino Merlino (pictured) and colleagues from the Donal O’Donoghue Renal Research Centre at Northern Care Alliance, working with collaborators in Italy, Belgium, the US and Greater Manchester Dementia Research Centre, showed for the first time that TRT is safe in CKD patients and is associated with improved survival.
The study compared 1,545 male CKD patients aged 18-80 being treated with TRT testosterone deficiency with the same number who were not treated, using anonymised medical records from more than 150 healthcare organisations around the world. Patients were followed up for up to five years.
Quality of life
Dr Merlino explained: “Testosterone deficiency can significantly affect quality of life, including mood issues, fatigue and memory problems. We know it’s a common condition among male CKD patients, including those receiving dialysis, but it isn’t always treated. In this study, just over two-thirds of patients who were affected weren’t receiving TRT, and this is probably because of concerns that it could increase cardiovascular issues – cardiovascular disease is a leading cause of death in kidney patients.
“Our research looked at patients with CKD stages 3-5, from moderately reduced kidney function to those with very severe or end-stage kidney failure. We found the health benefits of treating the deficiency applied across all the stages and for both those receiving dialysis and those not.
Significant impact
“Importantly, the risk of cardiovascular problems and prostate cancer was not significantly higher for men receiving testosterone replacement therapy, offering reassurance that this is safe.
“The findings could have a significant impact on the quality of life of testosterone-deficient CKD patients. They suggest we should assess many more patients for testosterone deficiency as part of routine care and treat those who would benefit.”
The research has been reported in the World Journal of Men’s Health. Lino Merlino, Francesco Rainone, James Tollitt, Michael Kalra, Sarah Williford, Francesca Rusconi, Graziana Battini, Ross Dunne, Geoffrey Hackett, Philip Kalra: Safety of testosterone therapy in chronic kidney disease: A propensity score-matched cohort study.