Salivary testosterone for the diagnosis of androgen deficiency in end-stage renal disease

CARDOSO EML, CONTRERAS LN, TUMILASCI EG, ELBERT A, AGUIRRE EC, AQUILANO DR, ARREGGER AL

NEPHROLOGY DIALYSIS TRANSPLANTATION

OXFORD UNIV PRESS

Año: 2011 vol. 26 p. 677 - 683

0931-0509

Abstract Background: Hypogonadism is frequent in patients with end stage renal disease (ESRD). Salivary testosterone (Sal-T) is a non invasive tool to screen androgen deficiency in adult male with normal renal function. However, available data on its utility in ESRD are not conclusive. Objective:1) to compare free testosterone fractions in saliva (SAL-T) and serum (Free-T); 2) to establish the correlation of Sal-T with circulating total (TT) and bioavailable testosterone(Bio-T); 3) to detect androgen deficiency through Sal-T, 4) to determine the correlation of Sal-T with clinical parameters. Methods:  the study included: 60 adult ESRD men on hemodialysis (20-60 y.o) with decreased libido referred from two dialysis centres; 112 eugonadic and 40 hypogonadic adult men with normal renal function as controls. Simultaneous morning saliva and serum samples were obtained for testosterone measurements by liquid RIA (SAL-T; TT).Free-T and Bio-T were calculated by Vermeulen equation.  Results: Sal-T (0.338± 0.177   nM) and Free-T (0.338 ± 0.165 nM)did not differ (p> 0.900) in ESRD as well as in C (0.337 ±0.182nM and 0.337 ±0.172 nM, respectively; p >0.900). Sal-T levels correlated positively (p< 0.0001) with Free-T(r=0.95), TT(r= 0.80) and Bio-T(r=0.76) in ESRD. Sal-T negatively correlated with age and years on dialytic therapy. Sal-T showed 100% sensitivity and specificity to differentiate patients with androgen deficiency (22%) from those with normal androgen levels (78%).Hypogonadism was hypergonadotrophic in 69% cases and hypogonadotrophic in 31%. Conclusions:These data demonstrate the value of morning Sal-T testing as a non invasive approach to screen androgen status in ESRD.