A study of the prevalence of gonadal dysfunction and its association with increasing disease severity in patients diagnosed with chronic kidney disease at a tertiary care center in Kolkata, West Bengal

Anant Parasher, Kunal Ranjan, Vanshika Munjal


Background: Hypergonadotropic hypogonadism is a well described hormonal derangement associated with chronic kidney disease, also known as uremic hypogonadism. The objective of this study was to assess the prevalence of gonadal dysfunction associated with chronic kidney disease and to study the co-relation of gonadal dysfunction with disease severity.

Methods: In this cross-sectional observational study, 50 patients with diagnosed chronic kidney disease were included during the one-year period from May 2015 to April 2016. The clinical and biochemical parameters related to gonadal dysfunction were evaluated in these cases.

Results: Out of the 28 male CKD patients, 19 (68%) patients had Serum Testosterone values less than 90 ng/dl, 18 (64%) patients had a serum leutinizing hormone (LH) level greater than 9 mIU/ml and 19 (68%) patients had a serum follicle stimulating hormone (FSH) level greater than 13 mIU/ml. Out of 22 female CKD patients, 14 (64%) patients had serum estradiol value less than 50 pg/ml, 12 (54%) patients had Serum LH level greater than 80 mIU/ml and 20 (91%) patients had a S. FSH level greater than 26 mIU/ml. Out of a total of 50 patients in this study, 34 patients showed evidence of gonadal dysfunction, the majority of them belonging to stage 5 CKD.

Conclusions: Out of the 34 patients showing gonadal dysfunction, 5 (15%) patients were in stage 3 CKD, 11 (32%) patient were in stage 4 CKD and 18 (53%) were in stage 5 CKD. It may be proposed that gonadal dysfunction is very common in CKD patients and the frequency of sexual dysfunction increases as the renal function deteriorates.




Chronic kidney disease, Gonadal dysfunction, Renal function, Uremic hypogonadism

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Foulks CJ, Cushner HM. Sexual dysfunction in the male dialysis patient: pathogenesis, evaluation, and therapy. Am J Kidney Dis. 1986;8:211-22.

Handelsman DJ. Hypothalamic-pituitary gonadal dysfunction in renal failure, dialysis and renal transplantation. Endocr Rev. 1985;6:151-82.

Holley JL. The hypothalamic-pituitary axis in men and women with chronic kidney disease. Adv Chronic Kidney Dis. 2004;11:337-41.

Bhasin S, Cunningham GR, Hayes FJ. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2010;95:2536-59.

Kalyani RR, Gavini S, Dobs AS. Male hypogonadism in systemic disease Endocrinol Metab Clin North Am. 2007;36:333-4.

Cardoso EM, Contreras LN, Tumilasci EG. Salivary testosterone for the diagnosis of androgen deficiency in endstage renal disease. Nephrol Dial Transplant. 2011;26:677-83.

Araujo AB, Esche GR, Kupelian V. Prevalence of symptomatic androgen deficiency in men. J Clin Endocrinol Metab. 2007;92:4241-7.

Gungor O, Kircelli F, Carrero JJ. Endogenous testosterone and mortality in male hemodialysis patients: is it the result of aging? Clin J Am Soc Nephrol. 2010;5:2018-23.

Karagiannis A, Harsoulis F. Gonadal dysfunction in systemic diseases. Eur J Endocrinol. 2005;152:501-13.

Albaaj F, Sivalingham M, Haynes P. Prevalence of hypogonadism in male patients with renal failure. Postgrad Med J. 2006;82:693-6.

Zhang R, Alper B, Simon E, Florman S, Slakey D. Management of metabolic bone disease in kidney transplant recipients. Am J Med Sci. 2008;335:120-5.

Anantharaman P, Schmidt RJ. Sexual function in chronic kidney disease. Adv Chronic Kidney Dis. 2007;14:119-25.

Palmer BF. Sexual dysfunction in men and women with chronic kidney disease and end-stage kidney disease. Adv Ren Replace Ther. 2003;10:48-60.

Stanley HL, Schmitt BP, Poses RM, Deiss WP. Does hypogonadism contribute to the occurrence of a minimal trauma hip fracture in elderly men? J Am Geriatr Soc. 1991;39:766-71.

De Celis R, Pedrón-Nuevo N. Male fertility of kidney transplant patients with one to ten years of evolution using a conventional immunosuppressive regimen. Arch Androl. 1999;42:9-20.

Finkelstein SH, Finkelstein FO. Evaluation of sexual dysfunction in dialysis patients. In: Nissenson AR, Fine RN, editors. Dialysis Therapy. 3rd ed. Philadelphia: Hanley and Belfus. 2002:368-73.

Palmer BF. Sexual dysfunction in uremia. J Am Soc Nephrol. 1999;10:13818.

Zingraff J, Jungers P, Pélissier C, Nahoul K, Feinstein MC, Scholler R. Pituitary and ovarian dysfunctions in women on haemodialysis. Nephron. 1982;30:149-53.

Coresh J, Selvin E, Stevens LA, Manzi J, Kusek JW, Eggers P et al. Prevalence of chronic kidney disease in the United States. JAMA. 2007;298:2038-47.

Snyder S, Pendergraph B. Detection and evaluation of chronic kidney disease. Am Fam Physician. 2005;72:1723-32.

Rajapurkar MM, John GT, Kirpalani AL, Abraham G, Agarwal SK, Almeida AF, et al. What do we know about chronic kidney disease in India: First report of the Indian CKD registry. BMC Nephrol. 2012;13:10.

Couser WG, Remuzzi G, Mendis S, Tonelli M. The contribution of chronic kidney disease to the global burden of major non-communicable diseases. Kidney Int. 2011;80(12):1258-70.

Levey AS, Atkins R, Coresh J. Chronic kidney disease as a global public health problem: approaches and initiatives - a position statement from Kidney Disease Improving Global Outcomes. Kidney Int Aug. 2007;72(3):247-59.

Kher V. End-stage renal disease in developing countries. Kidney Int. 2002;62(1):350-62.

Jha V. End-stage renal care in developing countries: The India Experience. Ren Fail. 2004;26(3):201-8.

Abram HS, Hester LR, Sheridan WF, Epstein GM. Sexual functioning in patients with chronic renal failure. J Nerv Ment Dis. 1975;160:220-6.

Carrero J, Qureshi A, Parini P. Low Serum Testosterone Increases Mortality Risk among Male Dialysis Patients. J Am Soc Nephrol. 2009;20(3):613-20.

Zingraff J, Jungers P, Pélissier C, Nahoul K, Feinstein MC, Scholler R. Pituitary and ovarian dysfunctions in women on haemodialysis. Nephron. 1982;30:149-53.

Eckersten D, Giwercman A. Asian J Androl. 2015;17(1):149-53.

Veldhuis JD, Wilkowski MJ, Zwart AD, Urban RJ, Lizarralde G, Iranmanesh A, et al. Evidence for attention of hypothalamine gonadotropin-releasing hormone (GnRH) impulse strength with preservation of GnRH pulse frequency in men with chronic renal failure. J Clin Endocrinol Metab. 1993;76:648-54.

Swamy AP, Woolf PD, Cestero RV. Hypothalmic pituitary-ovarian axis in uraemic women. J Lab Clin Med. 1979;93:1066-72.

Rudolf K, Kunkel S, Rudolf H, Falkenhagen D, Rüting M. Basal and gonadotropin releasing hormone-stimulated gonadotropin secretion in patients with chronic uraemia. Zentralbl Gynakol. 1988;110:683-8.

Peces R, Horcajada C, López-Novoa JM, Frutos MA, Casado S, Hernan. Hyperprolactinemia in chronic renal failure: impaired responsiveness to stimulation and suppression. Normalization after transplantation. Nephron. 1981;28:11-6.

Holly JL, Schmidt RJ, Bender FH, Dumler F, Schiff M. Gynecologic and reproductive issues in women on dialysis. Am J Kidney Dis. 1997;29:685-90.