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Meta-Analysis
. 2022 Sep 10:2022:3630429.
doi: 10.1155/2022/3630429. eCollection 2022.

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

Li Li  1 , Huixiang Ju  2 , Hao Jin  3 , Hongmei Chen  2 , Mingzhong Sun  2 , Zhongwei Zhou  2
Affiliations
Meta-Analysis

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

Li Li et al. J Healthc Eng. .

Abstract

The phenomenon of low testosterone level is extremely common in male patients with chronic kidney diseases (CKDs). This meta-analysis aimed to evaluate whether the low circulating testosterone could independently predict adverse outcomes among male patients with chronic kidney diseases (CKDs). The data till May 2022 were systematically searched from Pubmed, Web of Science, and Embase from inception. Studies meeting the PICOS (population, intervention/exposure, control/comparison, outcomes, and study design) principles were included in this meta-analysis. Study-specific effect estimates were pooled using fixed-effects (I 2 > 50%) or random-effects models (I 2 < 50%). Ultimately, 9 cohort studies covering 5331 patients with CKDs were involved in this meta-analysis. The results suggested that per 1-standard deviation (SD) decrease in total testosterone independently increased the risk of all-cause mortality by 27% [hazard risk (HR) 1.27, 95% confidence interval (CI) 1.16-1.38], cardiovascular mortality by 100% (HR 2.00, 95% CI 1.39-2.86), cardiovascular events by 20% (HR 1.20, 95% CI 1.04-1.39), and infectious events by 41% (HR 1.41, 95% CI 1.08-1.84). Besides, with per 1-SD decrease in free testosterone, the risk of overall adverse events increased by 66% (HR 1.66, 95% CI 1.34-2.05). Stratified analyses indicated that the negative relationship of the total testosterone with all-cause death risk was independent of factors involving age, race, body mass index, diabetes, hypertension, C-reactive protein, creatinine, and sex hormone binding globulin. In conclusion, it was identified that low endogenous testosterone could serve as an independent predictor of adverse clinical events among male patients with CKDs.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
The flow chart of the study selection process.
Figure 2
Figure 2
Forest plot of the association between per 1-SD decrease in total testosterone and adverse clinical events, including all-cause mortality, cardiovascular mortality, cardiovascular events, and infectious events. HR, hazard risk; CI, confidence interval.
Figure 3
Figure 3
Forest plot of the association between per 1-SD decrease in free testosterone and the overall adverse events. HR, hazard risk; CI, confidence interval.
Figure 4
Figure 4
Forest plot presenting subgroup analysis of the association between total testosterone and all-cause mortality. HR, hazard risk; CI, confidence interval.
Figure 5
Figure 5
Sensitivity analysis of the association between total testosterone and all-cause mortality. CI, confidence interval.
Figure 6
Figure 6
Funnel plot assessing potential publication bias for the association between total testosterone and all-cause mortality. HR, hazard risk.
See this image and copyright information in PMC

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