Testosterone Modifies the U-Shaped Association of the eGFR with All-Cause Mortality in Chinese Female Centenarians: A Prospective Cohort Study

 

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Testosterone Modifies the U-Shaped Association of the eGFR with All-Cause Mortality in Chinese Female Centenarians: A Prospective Cohort Study

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Yizhi
Chen
Yizhi Chen yizchen@126.com Hainan Hospital of Chinese PLA General Hospital Department of Nephrology Sanya China * Chinese PLA General Hospital Senior Department of Nephrology Beijing China
Zehao Zhang zzhnmnm@163.com Hainan Hospital of Chinese PLA General Hospital Department of Nephrology Sanya China -
Zeyu Qu qzy2001415@163.com Hainan Hospital of Chinese PLA General Hospital Department of Nephrology Sanya China -
Yue Niu niuyuesam@163.com First Medical Center of Chinese PLA General Hospital Senior Department of Nephrology Beijing China -
Zhe Feng zhezhe_4025@126.com First Medical Center of Chinese PLA General Hospital Senior Department of Nephrology Beijing China -
Weiguang Zhang weiguangzhang1@163.com First Medical Center of Chinese PLA General Hospital Senior Department of Nephrology Beijing China -
Ding Sun sending2013@126.com Hainan Hospital of Chinese PLA General Hospital Department of Nephrology Sanya China -
Hao Li 770867802@qq.com Hainan Hospital of Chinese PLA General Hospital Department of Nephrology Sanya China -
Qiushi Wang 1820642736@qq.com Hainan Hospital of Chinese PLA General Hospital Department of Nephrology Sanya China -
Miao Liu liumiaolmbxb@163.com Chinese PLA General Hospital Department of Anti-Nuclear, Biological, Chemical Medicine, Graduate School Beijing China -
Yali Zhao zhaoyl301@163.com Hainan Hospital of Chinese PLA General Hospital Central Laboratory Sanya China -
Yao He yhe301@sina.com Institute of Geriatrics, Beijing Key Laboratory of Geriatric Comorbidity, National Clinical Research Center for Geriatrics Diseases Second Medical Center, Chinese PLA General Hospital Beijing China -
Guangyan Cai caiguangyan@sina.com First Medical Center of Chinese PLA General Hospital Senior Department of Nephrology Beijing China -
Xiangmei Chen xmchen301@126.com First Medical Center of Chinese PLA General Hospital Senior Department of Nephrology Beijing China -
Bin Wang binwang2000@aliyun.com First Medical Center of Chinese PLA General Hospital Senior Department of Nephrology Beijing China -

The relationship between kidney function and mortality in centenarians, particularly concerning hormonal regulation, remains unclear. This study aimed to investigate the association between the estimated glomerular filtration rate (eGFR) and all-cause mortality in female centenarians and explore the potential role of testosterone.

Within the China Hainan Centenarian Cohort Study (CHCCS), 701 female centenarians (median age: 102 years) were enrolled. The eGFR was calculated via the CKD-EPI 2009 creatinine equation. Restricted cubic splines (RCSs) and multivariate Cox proportional hazards models were employed to assess nonlinear associations. Subgroup analysis and likelihood ratio tests were used to evaluate the interaction effect of testosterone.

During a median follow-up of 31 months, 643 participants (91.7%) died. The RCS revealed a significant nonlinear association (P-nonlinear = 0.007; P-overall = 0.001) between the eGFR and all-cause mortality, characterized by a U-shaped curve. Multivariate-adjusted Cox regression revealed that each 10 mL/min/1.73 m² increase in the eGFR was associated with a 6.2% reduction in all-cause mortality risk (HR = 0.938, 95% CI: 0.888–0.990, P = 0.021). Compared with centenarians with eGFRs of 45-<60 mL/min/1.73 m², those with eGFRs ≤45 mL/min/1.73 m² had a 42.3% increased risk of all-cause mortality (HR = 1.423, 95% CI: 1.156–1.751, P < 0.001) and a significantly shorter median survival time (26 months vs. 34 months, P < 0.001). Higher testosterone levels attenuated the association between the eGFR and all-cause mortality, indicating a protective effect (P for multivariate nonlinear interaction = 0.018).

In female centenarians, a lower eGFR (<45 mL/min/1.73 m²) is independently associated with all-cause mortality, and this association is modified by serum testosterone levels. These findings highlight testosterone as a potential modulator of the kidney function‒mortality relationship in centenarians, although the causal relationship requires further investigation.

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