Testosterone: A Modifiable Risk Factor to Prevent Cognitive Impairment in Indian Pre Dialysis Chronic Kidney Disease Patients

Background: cognitive and executive function impairment is common in predialysis CKD patients and occurs in even young patients. It is a major cause of morbidity. It impairs quality of life, hampers decision making and self-management of patients. Although initially subtle but may herald future and increase the burden on caregivers. Hence modifiable risk factors for cognitive impairment needs to be identified. Objective: To identify modifiable risk factors to prevent cognitive impairment in predialysis CKD patients. This will help to device a simple, reliable and non-invasive bedside marker to predict and prevent cognitive and executive functional impairment in patients of CKD. Methods: 70 CKD patients as defined by K/DOQI guidelines (kidney disease outcome quality initiative group) having an estimated GFR (eGFR)<60ml/min/1.73sq.mrtre, who had not undergone renal replacement therapy at the time of presentation were chosen as subjects of the study. They were compared with equal number of age and sex matched controls. Cognitive and executive functions of all cases and controls were assessed by using 6-item cognitive impairment test, MMSE, Trail making test-A and Trial making Test-B. All subjects underwent extensive blood and urine investigations. Testosterone level (samples were taken at 9 Am after overnight fasting) was done by a solid-phase enzyme immune assay by XEMA kit. Results: Serum testosterone mean value among cases was 1.941.17 and among control was 6.04 3.16 (p= 0.0005). Serum Testosterone levels was found to be significantly correlating with the impairment of cognitive function statistically (p value<0.005). Similarly, hyperuricemia also correlated with cognitive impairment in patients of CKD. (MMSE p =0.0001, 6CIT p =0.043 & TRAIL A &B p =0.0001). Impairment of cognitive function did not correlate statistically with any other parameter in this study. Multivariate regression analysis revealed that hyperuricemia correlated inversely and was the most important factor affecting cognitive function in predialysis CKD patients (r = -0.4259, p =0.0002) followed by serum testosterone (r = 0.282, p=0.0181). Conclusion: Early treatment of hyperuricemia and testosterone replacement therapy may go a long way in preventing the cognitive impairment in CKD patients.