الفهرس 
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Abstract
Anemia is a common complication of chronic kidney disease (CKD) which is associated with increased morbidity and mortality. Its prevalence is nearly 100% in patients with end stage renal disease (ESRD) or chronic hemodialysis (CHD). Although the etiology of anemia in CKD is multifactorial, diminishing erythropoietin production by the failing kidney is a major contributor.
Infact, erythropoiesis can be stimulated by testosterone via production of haematopoietic growth factors and possible improvement of iron bioavailability. In addition to that, Hypogonadism or testosterone deficiency is another prevalent condition in men with chronic CKD and may predispose to anemia in these patients.
Consequently, this study was carried out to study the effect of testosterone deficiency on the responsiveness to ESA therapy in the management of anemia in chronic HD male patient.
This cross sectional case control study was performed on 60 ESRD male patients on regular heamodialysis. Their mean age was 41.52±7.16 years. In addition to 20 healthy control individuals matched for age and sex.
All patients were selected from the Heamodialysis Unite of Mansoura Insurance Hospital /Egypt during the period from Mrch 2018 to December 2018.
A written consent was taken from all participants before enrollement in the study and the study was approved by the local medical ethical committe of the hospital.
All patients were receiving erythropoietin to treat anemia for at least 3 months and showed adequate iron stores (transferrin saturation (TSAT) of >20% and a serum ferritin level of >100 ng \ml) before the study.
Patients who received blood transfusion within 3 months before the study or were under testestosterone therapy were excluded from the study. In addition, patients with other chronic or endocrinal diseases and who treated by drugs that interfere with sex hormone synthesis as statins, ACEI, ARES, antidepressants, methotrexate were excluded. Moreover, other exclusion criteria included smoking, alcohol intake, obesity and active bleeding.
All participants were subjected to the following:
1- Careful medical history taking: including sexual function and dialysis history.
2- Thorough medical examination: with stress on dry body weight, height, BMI (kg/m2),blood pressure, manifestations of anemia and hypogonadism and full system examination.
3- Laboratory investigations including:
- Hemogloin level.
- Fating blood glucose.
- Fasting Lipid profile (total cholesterol, triglycerides, LDL and HDL).
- Viral markers (HCV antibodies, HBS antigen and HIV).
- Serum creatinine, Blood urea (pre and post dialysis) and serum creatinine, Kt /V and URR.
- Serum Albumin.
- Iron profile (S. iron, S. ferritin, Transferrin saturation and TIBC).
- PTH.
- Serum testosterone level.
- Erythropoietin resistive index (ERI).
The results of this study can be summarized as following:
1- There were a significant lower Hb level and a significant higher ferritin level in studied HD patients compared to controls. Also, the studied patients showed higher cholesterol and triglyceride levels compared with controls. Nearly two third (63%) of the included patients had HCV infection.
2- There was a significant difference between patients and controls regarding the sexual function.
3- Testosterone level was significantly lower in HD patients compared to controls with significant negative correlation with age.
4- 53.5% of patients showed sufficient testosterone level (>10 nmol/L) and 46.7% showed deficient level (< 10 nmol/L). There was a significant difference between both groups according to patient’s age and the sexual function. In addition, both groups were not significantly different in other studied parameters.
5- Most of the patients (53.3%) were receiving <12.000 unit of EPO/week and 46.7% were treated by ≥ 12.000 unit. Both groups showed significant differences in the weight, BMI, dry body weight, Hb levels and serum urea levels. In addition, patients with higher dose of EPO therapy showed significant lower HB levels.
6- ERI was calculated in all patients and its range was 11.53-35.35 with mean ± SD of 20.06±5.24. Then the patients were divided according to the median level of ERI (18.7) into two groups. The patient group with higher ERI (>18.7) showed a significant lower body weight, BMI, dry body weight, Hb level and serum ferritin level compared to those with lower median ERI group..
7- Regarding the relation between testosterone level and IQR ERI, there was a non significant difference in testosterone levels between different groups of ERI (divided according to IQR).
8- In addition, a significant correlation was not noticed between testosterone level and either EPO dose/week or ERI.
9- The result of logistic regression concerning testosterone deficiency showed that testosterone deficiency was significantly associated with age (OR: 1.186; 95%CI: 1.059-1.329).
It is obvious that deficiency of testosterone is common (46.7%) among studied patients with HD and is related to the sexual dysfunction in (100%) of patient; however it is not related to ERI among those patients. (p=.75).