Testosterone therapy in chronic kidney disease patients: an underutilized resource

Area of Science:

• Nephrology
• Endocrinology
• Geriatrics

Background:

• Testosterone deficiency is highly prevalent in men with chronic kidney disease (CKD), impacting 30-70% of patients.
• Hypogonadism in CKD is linked to adverse outcomes like anemia, malnutrition, muscle wasting, cardiovascular disease, and reduced quality of life.
• Despite its prevalence and impact, testosterone replacement therapy (TRT) is underutilized in the CKD population.

Purpose of the Study:

• To review and synthesize current evidence on the efficacy and safety of TRT in men with CKD.
• To evaluate the impact of TRT on various clinical parameters, including hematologic, nutritional, functional, and quality of life outcomes.
• To assess the potential renoprotective and cardiovascular safety profiles of TRT in CKD patients.

Main Methods:

• Systematic review and synthesis of evidence from randomized controlled trials, prospective registries, and observational studies.
• Analysis of data concerning hematologic parameters, nutritional markers, muscle strength, body composition, sexual function, and quality of life.
• Evaluation of emerging data on renoprotective effects and cardiovascular safety, including major adverse cardiac events, atrial fibrillation, and acute kidney injury.

Main Results:

• TRT in CKD patients demonstrated clinically meaningful improvements in hematologic parameters, nutritional status, muscle strength, body composition, sexual function, and quality of life.
• Emerging observational data suggest potential renoprotective effects, with preserved or improved estimated glomerular filtration rate in treated patients.
• Cardiovascular safety data indicate noninferiority to placebo for major adverse cardiac events, with a need for vigilance regarding atrial fibrillation and acute kidney injury.

Conclusions:

• TRT offers significant benefits for men with CKD suffering from testosterone deficiency, addressing multiple adverse outcomes.
• Transdermal testosterone gel provides a favorable pharmacokinetic profile, ensuring stable physiological levels and minimizing risks associated with supraphysiological peaks.
• Systematic screening for testosterone deficiency and individualized TRT should be integrated into comprehensive CKD management strategies.