• Mathis Grossmann, Rudolf Hoermann, Mark Ng Tang Fui, Jeffrey D Zajac, Franscesco L Ierino, and Matthew A Roberts.
• Department of Medicine Austin Health, University of Melbourne, Heidelberg, Vic., Australia; Endocrine Unit, Austin Health, Heidelberg, Vic., Australia.
• Clin. Endocrinol. (Oxf). 2015 May 1; 82 (5): 767-75.

ObjectiveOur objective was to characterize and evaluate prognostic implications of circulating sex steroids in patients at different stages of chronic kidney disease (CKD).DesignProspective observational cohort study.PatientsWe prospectively recruited patients with CKD III-IV, undergoing chronic dialysis and kidney transplant recipients (KTR) from a single centre in 2003-2004.MeasurementsTwo stored samples taken 3 months apart were analysed for sex hormones using liquid chromatography/tandem mass spectrometry, and the mean of the two was used for analysis. We also measured novel biomarkers troponin T and NT-proBNP. Patients were followed until death, transplant or 30 June 2013, and survival analysis performed.ResultsIn males, but not in females, both testosterone (P = 0·003) as well as oestradiol (P < 0·02) levels were lowest in dialysis patients and highest in KTR. Over a median follow up of 8·5 years (interquartile range 3·8-9·2), 52 men (36%) died and 24 (17%) received a kidney transplant. In Cox proportional hazards regression up to 9·6 years, an increase in total testosterone of 1 nmol/l was associated with a 9·8% (95% confidence interval 3·1-16·3) decrease in mortality independent of age, body mass index, stage of renal disease and circulating levels of NT-proBNP or troponin T. By contrast, sex steroid levels were not associated with mortality in females.ConclusionsTestosterone levels differ across stages of kidney disease and low testosterone levels predict mortality in males, independent of established and novel predictors of mortality.© 2014 John Wiley & Sons Ltd.

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