Lean Tissue Index and Body Cell Mass Can Be Predictors of Low Free Testosterone Levels in Men on Hemodialysis

Abstract

Objective: Testosterone deficiency is a common disorder among men treated with hemodialysis. The aim of our study was to evaluate the relationship between free testosterone levels and body composition, biochemical markers of nutritional status, and inflammation in men on hemodialysis.

Design: Prospective analysis of men treated with hemodialysis for more than 3 months in one hemodialysis center.

Subjects: A total of 56 men-41 men undergoing hemodialysis treatment thrice-weekly over a period of at least 3 months (HD group) and 15 men without kidney disease, with estimated glomerular filtration rate >60 mL/min/1.73 m² (C group)-were included. Serum levels of free testosterone, creatinine, protein, albumin, prealbumin, high-sensitivity C-reactive protein, and interleukin 6 and body composition by bioimpedance spectroscopy, waist-to-hip ratio, and waist-to-height ratio were measured.

Intervention: None, observational study.

Main outcome measure: Free testosterone level.

Results: The mean free testosterone level was significantly lower in the HD group than that in the C group and positively correlated with lean tissue index (LTI, r = 0.51, P = .001) and body cell mass (BCM, r = 0.57, P < .001). Significant, negative correlations were observed between free testosterone level and age (r = -0.4, P = .004) as well as fat tissue index (r = -0.36, P = .018). In a subgroup of men on hemodialysis who have low testosterone levels (<9.4 pg/mL), we observed a lower LTI and BCM and higher age, fat tissue index, and loginterleukin-6. In our receiver operating characteristic curve analysis, LTI and BCM were shown to be good predictors of a low testosterone level with cutoff points of 13.3 kg/m² and 22.3 kg, respectively, meaning that men on hemodialysis with LTI <13.3 kg/m² were 26 times more likely to have free testosterone levels below 9.4 pg/mL (odds ratio, 26.7; 95% confidence interval: 3.0-236.6).

Conclusion: Low lean tissue mass and BCM can be predictors of low testosterone level.