Skip to main content
Erschienen in: Clinical and Experimental Nephrology 1/2013

01.02.2013 | Original Article

Relationship between total testosterone, cognitive function, depressive behavior, and sleep quality in chronic kidney disease patients not on dialysis

verfasst von: Baris Afsar

Erschienen in: Clinical and Experimental Nephrology | Ausgabe 1/2013

Einloggen, um Zugang zu erhalten

Abstract

Background

Studies show that testosterone levels are associated with cognitive function, depression, and sleep quality in the general population. However, these relationships in chronic kidney disease (CKD) patients not on dialysis have not yet been evaluated before.

Methods

All patients underwent history taking, physical examination, blood pressure measurement, routine urine and biochemical analysis, 24-h urine collection to measure urinary protein excretion and creatinine clearance, and evaluation of cognitive function, depressive behavior, and sleep quality.

Results

In total, 109 CKD patients were enrolled. Total testosterone levels in stage 3, 4, and 5 CKD patients were 8.32 ± 4.35, 6.71 ± 3.12, and 4.22 ± 1.28 ng/ml, respectively (p < 0.0001). Post hoc analysis revealed that total testosterone levels were different between stages 3 and 5 (p < 0.0001) and stages 4 and 5 CKD patients (p < 0.0001) but not between stages 3 and 4 CKD patients (p 0.094). Standardized Mini Mental State Examination (SMMSE) score, Pittsburgh Sleep Quality Index (PSQI) score, and Beck Depression Inventory (BDI) score were 26.2 ± 1.9, 7.1 ± 3.4, and 8.6 ± 6.4, respectively. In linear regression analysis, total testosterone levels were independently associated with SMMSE score [b 0.170, confidence interval (CI) 0.047–0.293, p 0.008] and BDI score (b −0.750, CI −1.283 to −0.216, p 0.006) but not with sleep quality.

Conclusion

Total serum testosterone levels were independently associated with cognitive function and depressive behavior but not with sleep disorders in stage 3–5 CKD patients not on dialysis.
Literatur
1.
Zurück zum Zitat McQuillan R, Jassal SV. Neuropsychiatric complications of chronic kidney disease. Nat Rev Nephrol. 2010;6:471–9.PubMedCrossRef McQuillan R, Jassal SV. Neuropsychiatric complications of chronic kidney disease. Nat Rev Nephrol. 2010;6:471–9.PubMedCrossRef
2.
Zurück zum Zitat Sánchez-Román S, Ostrosky-Solís F, Morales-Buenrostro LE, Nogués-Vizcaíno MG, Alberú J, McClintock SM. Neurocognitive profile of an adult sample with chronic kidney disease. J Int Neuropsychol Soc. 2011;17:80–90.PubMedCrossRef Sánchez-Román S, Ostrosky-Solís F, Morales-Buenrostro LE, Nogués-Vizcaíno MG, Alberú J, McClintock SM. Neurocognitive profile of an adult sample with chronic kidney disease. J Int Neuropsychol Soc. 2011;17:80–90.PubMedCrossRef
3.
Zurück zum Zitat Jaber BL, Schiller B, Burkart JM, Daoui R, Kraus MA, Lee Y, et al. Impact of short daily hemodialysis on restless legs symptoms and sleep disturbances. Clin J Am Soc Nephrol. 2011;6:1049–56.PubMedCrossRef Jaber BL, Schiller B, Burkart JM, Daoui R, Kraus MA, Lee Y, et al. Impact of short daily hemodialysis on restless legs symptoms and sleep disturbances. Clin J Am Soc Nephrol. 2011;6:1049–56.PubMedCrossRef
4.
Zurück zum Zitat Pierratos A, Hanly PJ. Sleep disorders over the full range of chronic kidney disease. Blood Purif. 2011;31:146–50.PubMedCrossRef Pierratos A, Hanly PJ. Sleep disorders over the full range of chronic kidney disease. Blood Purif. 2011;31:146–50.PubMedCrossRef
5.
Zurück zum Zitat Pereira AA, Weiner DE, Scott T, Sarnak MJ. Cognitive function in dialysis patients. Am J Kidney Dis. 2005;45:448–62.PubMedCrossRef Pereira AA, Weiner DE, Scott T, Sarnak MJ. Cognitive function in dialysis patients. Am J Kidney Dis. 2005;45:448–62.PubMedCrossRef
6.
Zurück zum Zitat Kao TW, Lai MS, Tsai TJ, Jan CF, Chie WC, Chen WY. Economic, social, and psychological factors associated with health-related quality of life of chronic hemodialysis patients in northern Taiwan: a multicenter study. Artif Organs. 2009;33:61–8.PubMedCrossRef Kao TW, Lai MS, Tsai TJ, Jan CF, Chie WC, Chen WY. Economic, social, and psychological factors associated with health-related quality of life of chronic hemodialysis patients in northern Taiwan: a multicenter study. Artif Organs. 2009;33:61–8.PubMedCrossRef
7.
Zurück zum Zitat Bornivelli C, Alivanis P, Giannikouris I, Arvanitis A, Choustoulakis I, Georgopoulou K, et al. Relation between insomnia mood disorders and clinical and biochemical parameters in patients undergoing chronic hemodialysis. J Nephrol. 2008;13 Supp l:S78–83. Bornivelli C, Alivanis P, Giannikouris I, Arvanitis A, Choustoulakis I, Georgopoulou K, et al. Relation between insomnia mood disorders and clinical and biochemical parameters in patients undergoing chronic hemodialysis. J Nephrol. 2008;13 Supp l:S78–83.
8.
Zurück zum Zitat Muller M, Aleman A, Grobbee DE, de Haan EH, van der Schouw YT. Endogenous sex hormone levels and cognitive function in aging men: is there an optimal level? Neurology. 2005;64:866–71.PubMedCrossRef Muller M, Aleman A, Grobbee DE, de Haan EH, van der Schouw YT. Endogenous sex hormone levels and cognitive function in aging men: is there an optimal level? Neurology. 2005;64:866–71.PubMedCrossRef
9.
Zurück zum Zitat Moffat SD, Zonderman AB, Metter EJ, Blackman MR, Harman SM, Resnick SM. Longitudinal assessment of serum free testosterone concentration predicts memory performance and cognitive status in elderly men. J Clin Endocrinol Metab. 2002;87:5001–5007. Moffat SD, Zonderman AB, Metter EJ, Blackman MR, Harman SM, Resnick SM. Longitudinal assessment of serum free testosterone concentration predicts memory performance and cognitive status in elderly men. J Clin Endocrinol Metab. 2002;87:5001–5007.
10.
Zurück zum Zitat Yaffe K, Lui LY, Zmuda J, Cauley J. Sex hormones and cognitive function in older men. J Am Geriatr Soc. 2002;50:707–12.PubMedCrossRef Yaffe K, Lui LY, Zmuda J, Cauley J. Sex hormones and cognitive function in older men. J Am Geriatr Soc. 2002;50:707–12.PubMedCrossRef
11.
Zurück zum Zitat Giltay EJ, Tishova YA, Mskhalaya GJ, Gooren LJ, Saad F, Kalinchenko SY. Effects of testosterone supplementation on depressive symptoms and sexual dysfunction in hypogonadal men with the metabolic syndrome. J Sex Med. 2010;7:2572–82.PubMed Giltay EJ, Tishova YA, Mskhalaya GJ, Gooren LJ, Saad F, Kalinchenko SY. Effects of testosterone supplementation on depressive symptoms and sexual dysfunction in hypogonadal men with the metabolic syndrome. J Sex Med. 2010;7:2572–82.PubMed
12.
Zurück zum Zitat Barrett-Connor E, Von Mühlen DG, Kritz-Silverstein D. Bioavailable testosterone and depressed mood in older men: the Rancho Bernardo Study. J Clin Endocrinol Metab. 1999;84:573–7.PubMedCrossRef Barrett-Connor E, Von Mühlen DG, Kritz-Silverstein D. Bioavailable testosterone and depressed mood in older men: the Rancho Bernardo Study. J Clin Endocrinol Metab. 1999;84:573–7.PubMedCrossRef
13.
Zurück zum Zitat Wu JL, Wu RS, Yang JG, Huang CC, Chen KB, Fang KH, et al. Effects of sleep deprivation on serum testosterone concentrations in the rat. Neurosci Lett. 2011;494:124–9.PubMedCrossRef Wu JL, Wu RS, Yang JG, Huang CC, Chen KB, Fang KH, et al. Effects of sleep deprivation on serum testosterone concentrations in the rat. Neurosci Lett. 2011;494:124–9.PubMedCrossRef
14.
Zurück zum Zitat Andersen ml, Tufik S. The effects of testosterone on sleep and sleep-disordered breathing in men: its bidirectional interaction with erectile function. Sleep Med Rev. 2008;12:365–79.PubMedCrossRef Andersen ml, Tufik S. The effects of testosterone on sleep and sleep-disordered breathing in men: its bidirectional interaction with erectile function. Sleep Med Rev. 2008;12:365–79.PubMedCrossRef
15.
Zurück zum Zitat Penev PD. Association between sleep and morning testosterone levels in older men. Sleep. 2007;30:427–32.PubMed Penev PD. Association between sleep and morning testosterone levels in older men. Sleep. 2007;30:427–32.PubMed
16.
Zurück zum Zitat Junge W, Wilke B, Halabi A, Klein G. Determination of reference intervals for serum creatinine, creatinine excretion and creatinine clearance with an enzymatic and a modified Jaffe method. Clin Chim Acta. 2004;34:137–48.CrossRef Junge W, Wilke B, Halabi A, Klein G. Determination of reference intervals for serum creatinine, creatinine excretion and creatinine clearance with an enzymatic and a modified Jaffe method. Clin Chim Acta. 2004;34:137–48.CrossRef
17.
Zurück zum Zitat Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. Seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003;42:1206–52.PubMedCrossRef Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. Seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003;42:1206–52.PubMedCrossRef
18.
Zurück zum Zitat Molloy DW, Standish TI. A guide to the standardized mini-mental state examination. Int Psychogeriatr. 1997;9:87–94.PubMedCrossRef Molloy DW, Standish TI. A guide to the standardized mini-mental state examination. Int Psychogeriatr. 1997;9:87–94.PubMedCrossRef
19.
Zurück zum Zitat Güngen C, Ertan T, Eker E, Yaşar R, Engin Fl. Standardize Mini Mental Test’in Türk toplumunda hafif demans tanısında geçerlik ve güvenilirliği. Türk Psikiyatri Dergisi. 2002;13:273–281 Güngen C, Ertan T, Eker E, Yaşar R, Engin Fl. Standardize Mini Mental Test’in Türk toplumunda hafif demans tanısında geçerlik ve güvenilirliği. Türk Psikiyatri Dergisi. 2002;13:273–281
20.
Zurück zum Zitat Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:561–71.PubMedCrossRef Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:561–71.PubMedCrossRef
21.
Zurück zum Zitat Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28:193–213.PubMedCrossRef Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28:193–213.PubMedCrossRef
22.
Zurück zum Zitat Agargün MY, Kara H, Anlar O. Pittsburgh Uyku Kalitesi indeksinin Geçerliği ve Güvenirliği. Türk Psikiyatri Dergisi. 1996;7:107–15. Agargün MY, Kara H, Anlar O. Pittsburgh Uyku Kalitesi indeksinin Geçerliği ve Güvenirliği. Türk Psikiyatri Dergisi. 1996;7:107–15.
23.
Zurück zum Zitat Barrett-Connor E, Goodman-Gruen D, Patay B. Endogenous sex hormones and cognitive function in older men. J Clin Endocrinol Metab. 1999;84:3681–5.PubMedCrossRef Barrett-Connor E, Goodman-Gruen D, Patay B. Endogenous sex hormones and cognitive function in older men. J Clin Endocrinol Metab. 1999;84:3681–5.PubMedCrossRef
24.
Zurück zum Zitat Papasozomenos SC, Shanavas A. Testosterone prevents the heat shock-induced overactivation of glycogen synthase kinase-3 beta but not of cyclin dependent kinase 5 and c-Jun NH2-terminal kinase and concomitantly abolishes hyperphosphorylation of tau: implications for Alzheimer’s disease. Proc Natl Acad Sci USA. 2002;99:1140–5.PubMedCrossRef Papasozomenos SC, Shanavas A. Testosterone prevents the heat shock-induced overactivation of glycogen synthase kinase-3 beta but not of cyclin dependent kinase 5 and c-Jun NH2-terminal kinase and concomitantly abolishes hyperphosphorylation of tau: implications for Alzheimer’s disease. Proc Natl Acad Sci USA. 2002;99:1140–5.PubMedCrossRef
25.
Zurück zum Zitat Tirassa P, Thiblin I, Agren G, Vigneti E, Aloe L, Stenfors C. High-dose anabolic androgenic steroids modulate concentrations of nerve growth factor and expression of its low affinity receptor (p75-NGFr) in male rat brain. J Neurosci Res. 1997;47:198–207.PubMedCrossRef Tirassa P, Thiblin I, Agren G, Vigneti E, Aloe L, Stenfors C. High-dose anabolic androgenic steroids modulate concentrations of nerve growth factor and expression of its low affinity receptor (p75-NGFr) in male rat brain. J Neurosci Res. 1997;47:198–207.PubMedCrossRef
26.
Zurück zum Zitat Gouras GK, Xu H, Gross RS, Greenfield JP, Hai B, Wang R, et al. Testosterone reduces neuronal secretion of Alzheimer’s beta amyloid peptides. Proc Natl Acad Sci USA. 2000;97:1202–5.PubMedCrossRef Gouras GK, Xu H, Gross RS, Greenfield JP, Hai B, Wang R, et al. Testosterone reduces neuronal secretion of Alzheimer’s beta amyloid peptides. Proc Natl Acad Sci USA. 2000;97:1202–5.PubMedCrossRef
27.
Zurück zum Zitat Janowsky JS. Thinking with your gonads: testosterone and cognition. Trends Cogn Sci. 2006;10:77–82.PubMedCrossRef Janowsky JS. Thinking with your gonads: testosterone and cognition. Trends Cogn Sci. 2006;10:77–82.PubMedCrossRef
28.
Zurück zum Zitat Hogervorst E, Bandelow S, Moffat SD. Increasing testosterone levels and effects on cognitive functions in elderly men and women: a review. Curr Drug Targets CNS Neurol Disord. 2005;4:531–540. Hogervorst E, Bandelow S, Moffat SD. Increasing testosterone levels and effects on cognitive functions in elderly men and women: a review. Curr Drug Targets CNS Neurol Disord. 2005;4:531–540.
29.
Zurück zum Zitat Pouliot WA, Handa RJ, Beck SG. Androgen modulates N-methyl-D-aspartate-mediated depolarization in CA1 hippocampal pyramidal cells. Synapse. 1996;23:10–9.PubMedCrossRef Pouliot WA, Handa RJ, Beck SG. Androgen modulates N-methyl-D-aspartate-mediated depolarization in CA1 hippocampal pyramidal cells. Synapse. 1996;23:10–9.PubMedCrossRef
30.
Zurück zum Zitat Morse JK, DeKosky ST, Scheff SW. Neurotrophic effects of steroids on lesion-induced growth in the hippocampus. II. Hormone replacement. Exp Neurol. 1992;118:47–52.PubMedCrossRef Morse JK, DeKosky ST, Scheff SW. Neurotrophic effects of steroids on lesion-induced growth in the hippocampus. II. Hormone replacement. Exp Neurol. 1992;118:47–52.PubMedCrossRef
31.
Zurück zum Zitat Ahlbom E, Prins GS, Ceccatelli S. Testosterone protects cerebellar granule cells from oxidative stress-induced cell death through a receptor mediated mechanism. Brain Res. 2001;892:255–62.PubMedCrossRef Ahlbom E, Prins GS, Ceccatelli S. Testosterone protects cerebellar granule cells from oxidative stress-induced cell death through a receptor mediated mechanism. Brain Res. 2001;892:255–62.PubMedCrossRef
32.
Zurück zum Zitat Hammond J, Le Q, Goodyer C, Gelfand M, Trifiro M, LeBlanc A. Testosterone-mediated neuroprotection through the androgen receptor in human primary neurons. J Neurochem. 2001;77:1319–26.PubMedCrossRef Hammond J, Le Q, Goodyer C, Gelfand M, Trifiro M, LeBlanc A. Testosterone-mediated neuroprotection through the androgen receptor in human primary neurons. J Neurochem. 2001;77:1319–26.PubMedCrossRef
33.
Zurück zum Zitat Yao M, Nguyen TV, Rosario ER, Ramsden M, Pike CJ. Androgens regulate neprilysin expression: role in reducing amyloid levels. J Neurochem. 2008;105:2477–88.PubMedCrossRef Yao M, Nguyen TV, Rosario ER, Ramsden M, Pike CJ. Androgens regulate neprilysin expression: role in reducing amyloid levels. J Neurochem. 2008;105:2477–88.PubMedCrossRef
34.
Zurück zum Zitat Rosario ER, Carroll JC, Oddo S, LaFerla FM, Pike CJ. Androgens regulate the development of neuropathology in a triple transgenic mouse model of Alzheimer’s disease. J Neurosci. 2006;26:13384–9.PubMedCrossRef Rosario ER, Carroll JC, Oddo S, LaFerla FM, Pike CJ. Androgens regulate the development of neuropathology in a triple transgenic mouse model of Alzheimer’s disease. J Neurosci. 2006;26:13384–9.PubMedCrossRef
35.
Zurück zum Zitat Itil TM, Michael ST, Shapiro DM, Itil KZ. The effects of mesterolone, a male sex hormone in depressed patients (a double-blind controlled study). Methods Find Exp Clin Pharmacol. 1984;6:331–7.PubMed Itil TM, Michael ST, Shapiro DM, Itil KZ. The effects of mesterolone, a male sex hormone in depressed patients (a double-blind controlled study). Methods Find Exp Clin Pharmacol. 1984;6:331–7.PubMed
36.
Zurück zum Zitat Vogel W, Klaiber EL, Braverman DM. A comparison of the anti-depressant effect of a synthetic androgen (mesterolone) and amitriptyline in depressed men. J Clin Psychiatry. 1985;6:6–8. Vogel W, Klaiber EL, Braverman DM. A comparison of the anti-depressant effect of a synthetic androgen (mesterolone) and amitriptyline in depressed men. J Clin Psychiatry. 1985;6:6–8.
37.
Zurück zum Zitat Daly RC, Su TP, Schmidt PJ, Pickar D, Murphy DL, Rubinow DR. Cerebrospinal fluid and behavioral changes after methyltestosterone administration: preliminary findings. Arch Gen Psychiatry. 2001;58:172–7.PubMedCrossRef Daly RC, Su TP, Schmidt PJ, Pickar D, Murphy DL, Rubinow DR. Cerebrospinal fluid and behavioral changes after methyltestosterone administration: preliminary findings. Arch Gen Psychiatry. 2001;58:172–7.PubMedCrossRef
38.
Zurück zum Zitat Pope HG Jr, Cohane GH, Kanayama G, Siegel AJ, Hudson JI. Testosterone gel supplementation for men with refractory depression: a randomized, placebo-controlled trial. Am J Psychiatry. 2003;160:105–11.PubMedCrossRef Pope HG Jr, Cohane GH, Kanayama G, Siegel AJ, Hudson JI. Testosterone gel supplementation for men with refractory depression: a randomized, placebo-controlled trial. Am J Psychiatry. 2003;160:105–11.PubMedCrossRef
39.
Zurück zum Zitat Kurella TM, Wadley V, Yaffe K, McClure LA, Howard G, Go R, et al. Kidney function and cognitive impairment in US adults: the reasons for geographic and racial differences in Stroke (REGARDS) study. Am J Kidney Dis. 2008;52:227–34.CrossRef Kurella TM, Wadley V, Yaffe K, McClure LA, Howard G, Go R, et al. Kidney function and cognitive impairment in US adults: the reasons for geographic and racial differences in Stroke (REGARDS) study. Am J Kidney Dis. 2008;52:227–34.CrossRef
40.
Zurück zum Zitat Dai WS, Kuller LH, La Porte RE, Gutai JP, Falvo-Gerard L, Caggiula A. The epidemiology of plasma testosterone levels in middle-aged men. Am J Epidemiol. 1981;114:804–16.PubMed Dai WS, Kuller LH, La Porte RE, Gutai JP, Falvo-Gerard L, Caggiula A. The epidemiology of plasma testosterone levels in middle-aged men. Am J Epidemiol. 1981;114:804–16.PubMed
Metadaten
Titel
Relationship between total testosterone, cognitive function, depressive behavior, and sleep quality in chronic kidney disease patients not on dialysis
verfasst von
Baris Afsar
Publikationsdatum
01.02.2013
Verlag
Springer Japan
Erschienen in
Clinical and Experimental Nephrology / Ausgabe 1/2013
Print ISSN: 1342-1751
Elektronische ISSN: 1437-7799
DOI
https://doi.org/10.1007/s10157-012-0652-0

Weitere Artikel der Ausgabe 1/2013

Clinical and Experimental Nephrology 1/2013 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.