Abstract
This study aims to examine whether testosterone replacement therapy (TRT) can affect the incidence of cardiovascular events in men with chronic kidney disease (CKD). A retrospective cohort study was conducted using a national administrative claims data from 2007 to 2014 on adult males with diabetes and CKD stage 4 or 5. Men with panhypopituitarism, use of non-testosterone androgenic drugs, HIV/AIDS, and malignancy were excluded. Treatment group was composed of patients who received testosterone prescription or were administered testosterone as injection. The primary outcome was defined as the combined incidence of myocardial infarction (MI) and stroke. Secondary outcomes included incidences of congestive heart failure (CHF), coronary artery stents, coronary artery bypass surgery, secondary polycythemia, and prostate cancer. Multivariate Cox regression analyses were performed for each outcome adjusting for baseline demographic and clinical covariates. Of the eligible 225,720 adult men with CKD, 14% patients received testosterone treatment. Median follow up time was 1,296 days for men on TRT and 722 days for men who did not receive TRT. After controlling for baseline covariates, the combined incidence of MI and stroke was 31% lower in men who received TRT (aHR: 0.69, 95%CI: 0.66-0.73). The incidences of CHF (aHR: 0.72, 95% CI: 0.70-0.74), coronary artery stents (aHR: 0.80, 95% CI: 0.65-0.99), and coronary artery bypass surgery (aHR: 0.76, 95% CI: 0.62-0.95) were also lower in men who received TRT. The incidence of secondary polycythemia did not statistically differ between the study groups (aHR 1.18, 95% CI: 0.93-1.49). No men were diagnosed with incident prostate cancer during the follow-up period. The study suggests that TRT may decrease cardiovascular events in men with CKD stages 4 and 5. Randomized controlled trials of testosterone replacement in men with CKD are needed to establish the cardiovascular effects of TRT in these men.
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