Journal Article

Decreased serum adrenal androgen dehydroepiandrosterone sulfate and mortality in hemodialysis patients<sup>†</sup>

Ryusuke Kakiya, Tetsuo Shoji, Tomoshige Hayashi, Naoko Tatsumi-Shimomura, Yoshihiro Tsujimoto, Tsutomu Tabata, Hideaki Shima, Katsuhito Mori, Shinya Fukumoto, Hideki Tahara, Hidenori Koyama, Masanori Emoto, Eiji Ishimura, Yoshiki Nishizawa and Masaaki Inaba

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 27, issue 10, pages 3915-3922
Published in print October 2012 | ISSN: 0931-0509
Published online July 2012 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfs162
Decreased serum adrenal androgen dehydroepiandrosterone sulfate and mortality in hemodialysis patients†

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Background

Endocrine and metabolic abnormalities may affect the survival of hemodialysis patients. Serum dehydroepiandrosterone sulfate (DHEA-S), an adrenal androgen with anabolic properties, is known to be lowered in ill patients and predicts poor outcome in the general population and in those with cardiac disease. The aims of this study were to examine a possible change in the DHEA-S level in dialysis patients and its association with survival in this population.

Methods

This was an observational cohort study in 494 prevalent hemodialysis patients (313 men and 181 women) in urban area of Osaka, Japan. The main exposure was the baseline DHEA-S level in December 2004 and the key outcome was all-cause mortality during the subsequent 5 years. Also, DHEA-S levels were compared between the hemodialysis patients and 122 matched healthy controls.

Results

The median (inter-quartile range) DHEA-S levels were 771 (447–1351) and 414 (280–659) ng/mL for male and female dialysis patients, respectively, and these values were significantly lower by 40–53% than the healthy control levels. Among the hemodialysis patients, DHEA-S was lower in women, those with older age, pre-existing cardiovascular disease, lower serum albumin and higher C-reactive protein. During the follow-up, we recorded 101 deaths. A low DHEA-S level was a significant predictor of all-cause mortality independent of potential confounders in male, but not in female, hemodialysis patients.

Conclusions

The serum DHEA-S level is decreased in hemodialysis patients and associated with mortality in men. These results support the growing observational evidence that uremia-induced endocrine alterations including decreased sex hormones may be linked to adverse clinical outcomes.

Keywords: cardiovascular disease; dehydroepiandrosterone sulfate; hemodialysis; mortality; risk factor

Journal Article.  4918 words.  Illustrated.

Subjects: Nephrology

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