Low Testosterone Level and Risk of Adverse Clinical Events among Male Patients with Chronic Kidney Disease: A Systematic Review and Meta-Analysis of Cohort Studies

Table 1

Summary of clinical studies included in meta-analysis.

Author/year	Region	Study design	Patient types	Sample size	Age (years)	Comparison	Event number/adjusted HR (95% CI)	Follow-up (years)	Adjusted confounders	Overall NOS
Carrero et al. 2011 [17]	Turkey	Prospective cohort	Nondialysis CKD	239	52.0 ± 12.0	Per unit increase	CV events: 72; total testosterone: 0.83 (0.78–0.88); free testosterone: 0.65 (0.53–0.80)	2.58	Age, eGFR, diabetes, CVD, CRP, albumin, FMD	5
Gungor et al. 2009 [18]	Sweden	Prospective cohort	HD	126	63.0 ± 17.8	Low vs. high	Total death: 65; 1.51 (0.86–2.72); CV death: 38; 2.00 (0.80–4.95)	3.42	Age, SHBG, diabetes, CVD, ACEI/ARB medication, IL-6, albumin, creatinine	5
Yilmaz et al. 2010 [19]	Turkey	Prospective cohort	HD	420	54 ± 13	Lowest tertile 3 vs. highest	Total death: 104; 1.49 (0.83–2.66)	2.67	Age, BMI, HD duration, diabetes, CVD, albumin, creatinine, CRP	7
Kyriazis et al. 2011 [20]	Greece	Prospective cohort	HD	111	65 ± 12	Low vs. high	Total death: 49; total testosterone: 2.81 (1.23–6.38); free testosterone: 2.62 (1.27–5.44); CV death: 28; total testosterone: 2.29 (0.78–6.72); free testosterone: 2.47 (0.92–6.64)	3.08	Age, BMI, CVD, HD vintage, CRP, albumin, PWV	6
Khurana et al. 2014 [21]	America	Retrospective cohort	Nondialysis CKD	2149	67.3 ± 11.3	Lowest quintile 5 vs. highest	Total death: 357; 1.420 (0.995–2.020)	2.3	Age, BMI, race, smoking, eGFR, cerebrovascular disease, diabetes, hypertension, CAD, CHF, hyperlipidemia, albumin, malignancy, testosterone medication	8
Bello et al. 2014 [22]	Canada	Prospective cohort	HD	623	60.7 ± 15.2	Lowest tertile 3 vs. highest	Total death: 166; 1.48 (0.62–1.66); CV events: 98; 1.38 (0.60–3.19)	1.67	Age, BMI, smoking, SHBG, cancer, diabetes	6
Nakashima et al. 2017 [23]	Japan	Prospective cohort	HD	902	63.4 ± 11.8	Lowest tertile 3 vs. highest	Total death: 123; 2.26 (1.21–4.23); CV events: 151; 1.19 (0.74–1.91); infectious events, 116; 2.12 (1.18–3.79)	2.06	Age, BMI, albumin, creatinine, CRP, SHBG, ACEI/ARB medication; diabetes, history of CVD	8
Yu et al. 2017 [24]	America	Retrospective cohort	HD and PD	624	58 ± 14	Lowest tertile 3 vs. highest	Total death: 108; 2.32 (1.33–4.06)	1.2	Age, race, diabetes; dialysis vintage, cause of ESRD, modality, dialysis access, CHF, CHD, albumin	7
Wu et al. 2018 [25]	Taiwan	Retrospective cohort	HD	137	71.7 ± 9.4	Low vs. high	Total death: 61; 3.39 (1.67–6.86); CV death: 36; 6.13 (2.27–16.53)	5.0	Age, BMI, body composition, SMMI, diabetes, hypertension, albumin, creatinine, hemoglobin, CRP	6

Unless specified, adjusted HR (95% CI) represents effect estimates of total testosterone. HR, hazard ratio; CI, confidence interval; HD, hemodialysis; PD, peritoneal dialysis; CKD, chronic kidney disease; CV, cardiovascular; BMI, body mass index; SMMI, skeletal muscle mass index; CRP, C-reactive protein; ACEI, angiotensin-converting enzyme inhibitors; ARB, angiotensin II receptor blocker; SHBG, sex hormone binding globulin; CVD, cardiovascular disease; CHF, congestive heart failure; ESRD, end-stage renal disease; CHD, coronary heart disease; FMD, flow-mediated dilation; eGFR, estimated glomerular filtration rate; CAD, coronary artery disease; and PWV, pulse wave velocity.