Erectile dysfunction in chronic renal failure patients undergoing hemodialysis in Egypt

Clinical Implications and Risk Factors for Erectile Dysfunction in Kidney Transplant: A Single-Center Assessment

BACKGROUND

Erectile dysfunction (ED) affects the great majority of people undergoing dialysis and also the majority of patients undergoing kidney transplantation. In this study, we investigated the degree of erectile dysfunction (ED), as well as its prevalence, contributory variables, and overall impact after renal transplant.

METHODS

Adult male kidney transplant patients were the subject of an observational, non-interventional study that was conducted at a single center. Age, time and type of dialysis before transplantation, comorbidities, factors associated with cardiovascular risk, data on sexual history, physical examination, and laboratory results were among the clinical data we examined. In addition to gathering clinical and demographic characteristics, the International Index of Erectile Function (IIEF) questionnaire was used to evaluate sexual function.

RESULTS

A total of 170 renal transplanted patients between 20 and 70 years old (mean age: 45.40±11.5) were included in this study. All of the patients had immunosuppressive treatment with a calcineurin inhibitor (cyclosporine or tacrolimus) and had a normal glomerular filtration rate (GFR). The prevalence of sexual dysfunction increased with age (42.6% of patients under 40, 47.4% of patients in the 40-60 age group, and 78.9% of patients over 60). Mild, moderate, and severe ED was noted in 33.5%, 20.6%, and 10.6% of cases, respectively, and 51 (30%) patients reported having a normal sexual function. While calcium channel blockers (122 cases) were the most commonly used antihypertensive medication and chronic glomerulosclerosis (55.3%) was the most common cause of chronic kidney disease (CKD) before transplantation, none of these variables appear to have affected the severity of erectile dysfunction. The only medications associated with sexual dysfunction were alpha-blockers and aspirin (75 mg) (p=0.026 and p=0.013, respectively).

CONCLUSIONS

Although kidney transplantation has positive impacts on the quality of life, erectile dysfunction is a frequent condition among patients with renal transplants, and it has an increased frequency with age. In our study, it has been observed that only a small percentage of the research group had a normal sexual function, although most of the patients were young, and that alpha-blockers and aspirin (75 mg) are associated with erectile dysfunction.

Comparison of erectile function in patients with end-stage renal disease receiving haemodialysis and kidney transplantation

To investigate the frequency and risk factors of ED in haemodialysis patients (HDps) and kidney transplantation (KTx) recipients (KTxRs). HDps and KTxRs between the ages of 18-65 were compared in terms of ED. IEFF-15 (International Index of Erectile Function) score was used to evaluation of ED. Fifty-seven male HDps and 52 male KTxRs with a mean age of 45.6 ± 10.4 years were included in our study. DM, CAD, hyperlipidaemia, smoking and beta blocker use were higher HDps (p = 0.037, p < 0.001, p = 0.001, p = 0.001 and p = 0.031 respectively). There was no ED in five (8.8%) HDps and 27(51.9%) KTxRx. Severity of ED was significantly higher in HDps (p < 0.001). In multiple logistic regression analysis, KTx was found the most relevant associated factor with ED. KTxRs had decreased risk for ED (OR = 0.09, 95% CI 0.02-0.30, p < 0.001). ED is significantly more common in HDps than KTxRs. Known risk factors for ED, HT, DM, CAD, HL, smoking, obesity and beta-blocker use were not related to ED in the HDps and KTxRs, and the KTx was positively effective for ED in patients undergoing renal replacement therapy.

A Comparison of Erectile Dysfunction Improvement Between Patients With Regular Hemodialysis and Patients With Continuous Ambulatory Peritoneal Dialysis

BACKGROUND

Erectile dysfunction (ED) is one of the sexual dysfunctions that are often encountered as a complication of male patients with stage 5 chronic kidney disease (stage 5 CKD). ED can be caused by psychological factors in patients with regular dialysis therapy. Currently, Hemodialysis (HD) therapy is the first choice in dialysis therapy and only 2% of stage 5 CKD patients are using Continuous Ambulatory Peritoneal Dialysis (CAPD) as a dialysis therapy. ED in stage 5 CKD patients should become a part of the treatment of patients with dialysis, which hopefully will improve the quality of life of patients. This study aims to compare the improvement in ED degree in patients with HD and CAPD.

METHOD

This study is an observational analytic comparative study involving 44 male patients with stage 5 CKD; 22 of whom underwent HD and the remaining 22 patients underwent CAPD. The differences evaluated were changes in the ED degree before and after dialysis, which were assessed using the International Index of Erectile Function-5 (IIEF-5).

RESULT

There were significant differences in the improvement in ED degree and IIEF-5 scores in CAPD group. In the HD group, no significant difference was obtained in the improvement in ED degree and IIEF-5 score. A significant difference was obtained in the improvement in ED degree between the HD and CAPD groups by comparing the improvement in IIEF-5 score.

CONCLUSION

Patients with CAPD have a better improvement in ED degree than patients with HD. Duarsa GWK, Kandarini Y, Winarta GK, et al. A Comparison of Erectile Dysfunction Improvement Between Patients With Regular Hemodialysis and Patients With Continuous Ambulatory Peritoneal Dialysis. J Sex Med Rev 2021;18:920-925.

Erectile dysfunction pattern in patients with end stage renal disease on regular dialysis

INTRODUCTIONS

Evaluating the epidemiology, pattern, and contributing factors of sexual dysfunction in end-stage renal disease (ESRD) patients is the cornerstone in understanding and enhancing these patients' quality of life. In this study, we aimed to identify the different patterns of erectile dysfunction (ED) among 100 patients undergoing hemodialysis.

MATERIALS AND METHODS

A single-center, cross-sectional, study was conducted on 100 patients with ESRD on hemodialysis. Patients were assessed using the International index of erectile dysfunction (IIEF) and Doppler assessment of the penis.

RESULTS

A total of 100 patients were included in this study with a mean age of 48.77 ± 9.66 years old. The mean erectile index was 7.10 ± 4.62; while the mean free and total testosterone were 10.07 ± 7.69 and 2.93 ± 1.4 ng/dL, respectively. Overall, 67% of the patients had abnormal hormonal levels. Concerning the penile vasculature, 71% of the patients had arterogenic importance and 19% had venous impotence. The comparative analysis demonstrated that hypertensive patients had lower erectile index (p = 0.002). In addition, smokers had lower erectile index (p < 0.001). There was statistical significance between normal hormonal and abnormal hormone level according to erectile index, with lower index in patients with abnormal hormonal level (p = 0.03).

CONCLUSION

In conclusion, our findings indicate that the most common causes of ED with renal failure were hormonal disturbance, including testosterone, and prolactin. Hypertension and smoking are major contributing factors that should be managed carefully to reduce the risk of ED and improve the quality of life.

Significant Increase of Sexual Dysfunction in Patients With Renal Failure Receiving Renal Replacement Therapy: A Systematic Review and Meta-Analysis

BACKGROUND

It has been shown that sexual dysfunction (SD) is highly prevalent among patients with chronic renal failure (CRF), and starting renal replacement therapy may even increase it. However, SD is an infrequently reported problem in these treated patients.

AIM

To investigate the prevalence of SD among patients with CRF undergoing renal replacement therapy, by a meta-analysis method.

METHODS

PubMed, Embase, and the Cochrane Library were systematically searched for all studies assessing sexual function in patients with CRF receiving renal replacement therapy from January 2000 to April 2020. Relative risk (RR) with 95% CIs was used for analysis to assess the risk of SD in patients with CRF receiving renal replacement therapy. The cross-sectional study quality methodology checklist was used for the cross-sectional study. The methodologic quality of the case-control and cohort studies was assessed with the Newcastle-Ottawa Scale. Data were pooled for the random-effect model. Sensitivity analyses were conducted to assess potential bias. The Begg and Egger tests were used for publication bias analysis.

OUTCOMES

The prevalence of SD among patients with CRF receiving renal replacement therapy was summarized using pooled RR and 95% CI.

RESULTS

This meta-analysis included 3,725 participants from 10 studies. Of these, 737 were patients with CRF receiving renal replacement therapy. The mean age of participants ranged from 32.75 to 56.1 years. Based on the random-effect model, synthesis of results demonstrated that the prevalence of SD was significantly increased among patients with CRF receiving renal replacement therapy in women (RR = 2.07, 95% CI: 1.47-2.91, P = .000; heterogeneity: I² = 78.7%, P = .000) and in men (RR = 2.95, 95% CI: 2.16-4.02, P = .000; heterogeneity: I² = 86.1%, P = .000). Estimates of the total effects were generally consistent in the sensitivity analysis. No evidence of publication bias was observed.

CLINICAL IMPLICATIONS

Patients with CRF receiving renal replacement therapy had a significantly increased risk of SD, which suggests that clinicians should evaluate sexual function, when managing patients with CRF receiving renal replacement therapy.

STRENGTHS AND LIMITATIONS

This is the first study to explore the prevalence of SD among patients with CRF undergoing renal replacement therapy based on all available epidemiologic studies. However, all included studies were an observational design, which may downgrade this evidence.

CONCLUSION

The prevalence of SD is significantly increased among patients with CRF receiving renal replacement therapy. More research studies are warranted to clarify the relationship. Luo L, Xiao C, Xiang Q, et al. Significant Increase of Sexual Dysfunction in Patients With Renal Failure Receiving Renal Replacement Therapy: A Systematic Review and Meta-Analysis. J Sex Med 2020;17:2382-2393.

Psychiatric Comorbidity, Sexual Dysfunction, and Quality of Life in Patients Undergoing Hemodialysis: A Case-Control Study

INTRODUCTION

Due to disabilities caused by the disease and the requirement of dialysis, end-stage renal disease (ESRD) is frequently comorbid with psychiatric disorders, adversely affects quality of life, and causes significant sexual dysfunction (SD). We aimed to investigate the psychiatric comorbidity, quality of life, depression and anxiety levels, and SD in ESRD patients undergoing hemodialysis.

METHODS

Forty-nine patients undergoing hemodialysis treatment in a dialysis center and 44 non-ESRD control subjects selected with snowball sampling were enrolled in the study. All subjects were assessed using Structured Clinical Interview for Axis-I Disorders (SCID-I). Sociodemographic data form, Hospital Anxiety and Depression Scale (HADS), Arizona Sexual Experience Scale (ASEX), and World Health Organization Quality of Life Short Form Turkish Version Scale (WHOQOL-BREF-TR) were applied to both groups.

RESULTS

There was no difference between the groups in terms of sex, age, education period, marital status, presence of additional physical illness, and past history of psychiatric disorders. Compared with the control group, HADS depression subscale and ASEX scores were significantly high (p<0.01) in the patient group, and WHOQOL-BREF-TR psychological and physical domain scores were low (p<0.05 and p<0.01, respectively). There was a significant negative relationship between HADS scores and WHOQOL-BREF-TR psychological, environmental, and national environmental scores in the patient group (p<0.05). When the differences between the groups were re-analyzed after controlling HADS depression scores with covariance analysis, the significant difference in ASEX and WHOQOL-BREF-TR physical domain scores between the groups remained, but the significant difference in WHOQOL-BREF-TR psychological domain scores disappeared.

CONCLUSION

The quality of life of ESRD patients was lower, especially in the psychological and physical domains, and psychiatric comorbidities and SD rates were higher than in non-ESRD control subjects. Quality of life is affected by SD. Recognizing and treating depressive symptoms will help improve the quality of life, especially in the psychological domain.

Sexual dysfunction in patients with peripheral nervous system lesions

Peripheral nervous system (PNS) disorders may cause sexual dysfunction (SD) in patients of both genders. These disorders include mainly polyneuropathies (particularly those affecting the autonomic nervous system (ANS)) and localized lesions affecting the innervation of genital organs. Impaired neural control may produce a malfunction of the genital response consisting of loss of genital sensitivity, erectile dysfunction, loss of vaginal lubrication, ejaculation disorder, and orgasmic disorder. In addition, there is often a loss of desire which actually has a complex pathogenesis, which goes beyond the mere loss of relevant nerve function. In patients who have no manifest health problems - particularly men with erectile dysfunction - one should always consider the possibility of an underlying polyneuropathy; in patients with SD after suspected denervation lesions of the innervation of genital organs within the lumbosacral spinal canal and in the pelvis, clinical neurophysiologic testing may clarify the PNS involvement. SD can alter self-esteem and lower patients' quality of life; opening up a discussion on sexual issues should be a part of the management of patients with PNS disorders. They may greatly benefit from counseling, education on coping strategies, and specific treatments.

Erectile dysfunction in chronic hemodialysis patients in dakar: a cross-sectional study in 2012

BACKGROUND

Patients with chronic kidney disease (CKD) experience multiple complications including erectile dysfunction (ED). It involves more than 50% of patients on dialysis or transplant. In Africa, the true extent of ED in CKD is unknown although some studies have been done in this regard.

OBJECTIVES

This study aimed to determine the prevalence and identify risk factors of ED in patients on hemodialysis.

PATIENTS AND METHODS

This cross-sectional multicenter study was conducted from January 2, 2012 through April 30, 2012 in four hemodialysis centers in Dakar. We included all patients on chronic hemodialysis who aged ≥ 18 years old and freely consented to participate in the study. Sociodemographic, clinical, and hemodialysis data were collected through a questionnaire. Erectile function was assessed by a short version of International Index of Erectile Function (IIEF-5).

RESULTS

Among a target of 80 patients, 73 met the inclusion criteria and were included in this study. Mean dialysis vintage was 27.3 months (range, 1-156). Their mean age was 53.81 ± 12.52 years, with a higher proportion of age group of 50 to 69 years old. Fifty-six patients were married (37 monogamous and 19 polygamous) and six were singles. Overall prevalence of ED was 84.9% and it was severe in 14 patients (19.2%). Hypertension and diabetes were the most frequent etiologies and antihypertensive treatment was used in 95.5%. The main factors associated with ED were age > 50 years old and polygamy.

CONCLUSIONS

ED is a common problem among patients on hemodialysis in Dakar with a high prevalence. Aging and diabetes represent most common causes. More efforts are needed for its early detection, prevention, and multidisciplinary management.

Associated factors and prevalence of erectile dysfunction in hemodialysis patients

PURPOSE

The proposal of this study was to determine the prevalence and the associated factors of erectile dysfunction (ED) among hemodialysis (HD) patients.

MATERIALS AND METHODS

This was a cross-sectional study based on data collected from HD male patients. Clinical, demographic and laboratory data of all patients were collected in three HD clinics from December 2010 to June 2011. Patients answered questions of erectile function domain from International Index of Erectile Function. Data were evaluated by descriptive analysis and by univariate (ULRA) and multivariate logistic regression analysis (MLRA).

RESULTS

Three hundred and five patients participated of the study. The prevalence of ED was 68.19%. ED was associated with diabetes (DM), benign prostatic hyperplasia, glomerulonephritis as cause of chronic renal failure (CRF), smoking habits, lower creatinine levels (ULRA), use of calcium channel blocker (MLRA), aging, lower education level, alcohol consumption, DM (as cause of CRF) and coronary insufficiency (ULRA and MLRA).

CONCLUSIONS

ED was highly prevalent in the HD men. It was independently associated with aging, current use of alcohol, long alcohol use (even for those who do not drink more), lower education level, diabetes as cause of CRF, coronary insufficiency and use of channel blockers calcium.

Erectile dysfunction in hemodialysis: A systematic review

Men with chronic renal failure (CRF) on hemodialysis have been frequently associated with erectile dysfunction (ED), with an of between 20% to 87.7%. As a result of the multi-system disease processes present in many uremic men, it is apparent that the pathogenesis of ED is most probably multifactorial. Factors to be considered include peripheral vascular disease, neurogenic abnormalities, hormonal disturbances and medications used for treatment of conditions associated with CRF. These physiological abnormalities may be supplemented by significant psychological stresses and abnormalities resulting from chronic illness. Treatment must start with the determination and treatment of the underlying causes. In addition to psychological treatment, further lines of treatment of ED in CRF can be classified as 1st line (medical treatment which includes oral phosphodiesterase-5 inhibitors and hormone regulation), 2nd line (intracavernosal injection, vacuum constriction devices and alprostadil urethral suppositories) or 3rd line (surgical treatment). Renal transplantation improves the quality of life for some patients with CRF and subsequently it may improve erectile function in a significant number of them, however still there is high incidence of ED after transplantation.

La dysfonction érectile chez les patients hémodialysés au CNHU-HKM de Cotonou: profil épidémiologique

But

Étudier le profil épidémiologique de la dysfonction érectile (DE) chez les hémodialysés du CNHU.

Matériels et méthodes

Il s’agissait d’une étude transversale descriptive réalisée par l’équipe du service d’urologie dans le service d’hémodialyse du CNHU de Cotonou portant sur 58 patients hémodialysés. La forme abrégée de l’Index international de la fonction érectile (IIEF-5) a été utilisée pour l’appréciation de la fonction érectile. Un questionnaire préétabli a permis de recueillir les données sur le profil épidémiologique des patients.

Résultats

Les patients étaient âgés de 27 à 78 ans avec une moyenne d’âge de 56,3 ans. 96,6 % de nos patients étaient mariés dont 10,3 % de polygames. Les principales étiologies de l’insuffisance rénale chronique (IRC) étaient l’hypertension artérielle (HTA) mal suivie (87,9 %) et le diabète (12,1 %). La prévalence de la DE était de 75,9 % dont 29,3 % de DE sévères. Certains facteurs étiologiques ont été retrouvés en ce qui concerne la DE: il s’agissait de l’alcool (36,2 %) et du tabac (12,1 %). La DE était présente chez 9,1 % des patients avant la découverte de l’insuffisance rénale, et 72,7 % des patients avaient affirmé avoir constaté l’insuffisance érectile avec le début des séances de dialyse. Pour 39 patients (88,6 %), la DE se serait accentuée au cours des séances de dialyses. Les troubles sexuels associés étaient une baisse de la libido chez 25 % des patients (11/44) et une éjaculation précoce chez 34,1 % (15/44). Une hypotension artérielle a été notée chez 25 % des patients (11/44). Une hyperglycémie a été retrouvée chez 22,7 % des patients (10/44).

Conclusion

La DE, complication fréquente survenant sur les terrains d’IRC, a un impact négatif sur la qualité de la sexualité de nos patients hémodialysés. Une prise en charge de ce trouble devrait permettre d’améliorer la qualité de vie de ces derniers.

Qualitative inquiry: perceptions of sexuality by African Americans experiencing haemodialysis

AIM

To explore the influence of the haemodialysis regimen on African Americans' perceptions of sexuality.

BACKGROUND

Sexuality is defined as the quality of humans as males or females. Sexuality concerns are commonly reported for individuals receiving haemodialysis; yet, sexuality-related research for this population has been limited to a focus on altered physical sexuality characteristics.

DESIGN

Qualitative descriptive study.

METHODS

This qualitative descriptive study used a middle-range model derived from Roy's adaptation model to explore a holistic viewpoint of African Americans' perceptions of physical sexuality, personal sexuality identity, family/social roles, and intimate/personal relationships since being on dialysis. Data were collected over a 9-month period in 2008-2009.

FINDINGS

Semi-structured interviews were conducted with 19 African American men (N = 12) and women (N = 7) who were receiving haemodialysis treatment (mean age = 49·95 years). Perceptions of diminished sexuality were most associated with altered relationships, family and social roles for most participants, and were suggested to negatively influence adaptive processes. Perceptions of personal sexuality identity in male participants were found to be greatly influenced by endorsement of traditional masculinity ideology. In contrast, female participants' perceptions of sexuality were found to be influenced by multiple meanings of their identity as Black women.

CONCLUSION

These findings suggest that diminished perceptions of sexuality may negatively influence adaptive processes for patients receiving chronic treatment such as dialysis. In addition, findings support further research and the development of instruments to assess sexuality from a more holistic viewpoint.

Prevalence and correlates of erectile dysfunction in men on chronic haemodialysis: a multinational cross-sectional study

BACKGROUND

Factors associated with erectile dysfunction in men on haemodialysis are incompletely identified due to suboptimal existing studies. We determined the prevalence and correlates of erectile dysfunction and identified combinations of clinical characteristics associated with a higher risk of erectile dysfunction using recursive partitioning and amalgamation (REPCAM) analysis.

METHODS

We conducted a multinational cross-sectional study in men on haemodialysis within a collaborative network. Erectile dysfunction and depressive symptoms were evaluated using the erectile function domain of the International Index of Erectile Function questionnaire and the Center for Epidemiological Studies-Depression Scale, respectively.

RESULTS

Nine hundred and forty-six (59%) of 1611 eligible men provided complete data for erectile dysfunction. Eighty-three per cent reported erectile dysfunction and 47% reported severe erectile dysfunction. Four per cent of those with erectile dysfunction were receiving pharmacological treatment. Depressive symptoms were the strongest correlate of erectile dysfunction [adjusted odds ratio 2.41 (95% confidence interval (CI) 1.57-3.71)]. Erectile dysfunction was also associated with age (1.06, 1.05-1.08), being unemployed (1.80, 1.17-2.79) or receiving a pension (2.05, 1.14-3.69) and interdialytic weight gain (1.9-2.87 kg, 1.92 [CI 1.19-3.09]; >2.87 kg, 1.57 [CI 1.00-2.45]). Married men had a lower risk of erectile dysfunction (0.49, 0.31-0.76). The prevalence of erectile dysfunction was highest (94%) in unmarried and unemployed or retired men who have depressive symptoms.

CONCLUSIONS

Most men on haemodialysis experience erectile dysfunction and are untreated. Given the prevalence of this condition and the relative lack of efficacy data for pharmacological agents, we suggest that large trials of pharmacological and non-pharmacological interventions for erectile dysfunction and depression are needed.

Erectile dysfunction in Arab countries. Part I: Prevalence and correlates

OBJECTIVE

To review the contemporary knowledge of local investigations in the Arab countries that were conducted to identify the magnitude of erectile dysfunction (ED) and its correlates among men in this region.

METHODS

MEDLINE was reviewed for English-language reports from 2000 to 2011 for Arab countries, using the terms 'erectile dysfunction' and 'prevalence'.

RESULTS

In all, 102 articles were found to be relevant to the review. Unfortunately only a few had a high level of evidence and the remaining studies were not controlled in their design. Several local studies showed that the prevalence of ED was >40% among Arab men. Risk factors and medical comorbidities that negatively affect the cardiovascular system, endothelial function and ultimately erectile function were common in men in Arab countries. For instance, at least five Arab countries are included in the top 10 countries worldwide with a high prevalence of diabetes mellitus. The global statistics showed that other risk factors such as obesity, smoking, hypertension and dyslipidaemia are also very prevalent in Arab countries. This fact can explain the high incidence of both cardiovascular disease and ED among Arab men.

CONCLUSION

ED is very prevalent among Arab men. Arab countries are among those with the highest prevalence of endothelial dysfunction risk factors, which could explain this high prevalence of ED.

The burden of erectile dysfunction in dialysis patients in Senegal

Erectile dysfunction (ED) is very common in dialysis patients because of organic and psychological risk factors. It has a negative impact on patients' quality of life. In Senegal, ED is assumed to be frequent in the general adult population but its prevalence in dialysis patients is unknown. This cross-sectional study aimed to assess the prevalence and risk factors associated with ED in Senegalese dialysis patients. Seventy dialyzed men >18 years old were included. Erectile dysfunction was assessed using the abridged version of International Index of Erectile Function already validated in dialysis patients. Multivariate analysis was performed to identify the factors associated with ED in patients. The mean age of the patients was 52 ± 11.3 years (21-70 years) and the median dialysis vintage was 39.4 months (interquartile range 9-51 months). The prevalence of ED was 81.5% for all patients (80% in hemodialysis and 81.75% in peritoneal dialysis). Severe ED was found in 11.5% of patients. The prevalence of ED was 74.5% in patients younger than 50 years and 86.6% in those 50 years or older. Marital status, comorbidity, hemoglobin level, and use of antihypertensive drugs were not different between patients with and without ED. Libido was conserved in 77% of patients and 44.7% were not satisfied during sexual intercourse. Multivariate analysis identified age and dialysis vintage as risk factors of ED in our patients. Only 7 patients received treatment for ED and 22% sought a consultation with a specialist (urologist and psychologist).

Prevalence and correlates of self-reported sexual dysfunction in CKD: a meta-analysis of observational studies

BACKGROUND

Sexual dysfunction is an under-recognized problem in men and women with chronic kidney disease (CKD). The prevalence, correlates, and predictors of this condition in patients with CKD have not been evaluated comprehensively.

STUDY DESIGN

Systematic review and meta-analysis.

SETTING & POPULATION

Patients treated using dialysis (dialysis patients), patients treated using transplant (transplant recipients), and patients with CKD not treated using dialysis or transplant (nondialysis nontransplant patients with CKD).

SELECTION CRITERIA FOR STUDIES

Observational studies conducted in patients with CKD only or including a control group without CKD.

PREDICTOR

Type of study population.

OUTCOMES

Sexual dysfunction in men and women with CKD using validated tools, such as the International Index of Erectile Function, the Female Sexual Function Index (FSFI), or other measures as reported by study investigators.

RESULTS

50 studies (8,343 patients) of variable size (range, 16-1,023 patients) were included in this review. Almost all studies explored sexual dysfunction in men and specifically erectile dysfunction. The summary estimate of erectile dysfunction in men with CKD was 70% (95% CI, 62%-77%; 21 studies, 4,389 patients). Differences in reported prevalence rates of erectile dysfunction between different studies were attributable primarily to age, study populations, and type of study tool used to assess the presence of erectile dysfunction. In women, the reported prevalence of sexual dysfunction was assessed in only 306 patients from 2 studies and ranged from 30%-80%. Compared with the general population, women with CKD had a significantly lower overall FSFI score (8 studies or subgroups, 407 patients; mean difference, -9.28; 95% CI, -12.92 to -5.64). Increasing age, diabetes mellitus, and depression consistently were found to correlate with sexual dysfunction in 20 individual studies of patients with CKD using different methods.

LIMITATIONS

Suboptimal and lack of uniform assessment of outcome measures.

CONCLUSIONS

Sexual dysfunction is highly prevalent in both men and women with CKD, especially among those on dialysis. Larger studies enrolling different ethnic groups, using validated study tools, and analyzing the influence of various factors on the development of sexual dysfunction are needed.

Sexual dysfunction in uraemic patients undergoing haemodialysis: predisposing and related conditions

Chronic kidney disease and sexual dysfunction are common entities in clinical practice in haemodialysis (HD) units. This article is a review of some articles that focus on sexual dysfunction in patients undergoing HD and its possible relationship in multiple ways.

Erectile dysfunction risk factors for patients entering dialysis programme

The objective of this study was to determine the risk factors of erectile dysfunction (ED) for patients entering the dialysis programme with haemodialysis (HD) or peritoneal dialysis (PD). Participants were adult males with sexual partners. They were given the semi-quantitative standard International Index of Erectile Function questionnaire. We added the common risk factors in specially designed questions to cover our objectives. The data were analysed using a multivariate regression model. Fifty-two patients fulfilled the eligibility criteria and completed this questionnaire. Twenty-five were on HD and 27 on PD. Only 17.3% were potent on entry into the study. Among the rest 71% were classified under severe ED. Sexual desire appeared less affected in comparison to other domains. Although 66.6% expressed their interest in treatment for ED, none of the patients received any. Stepwise selection analysis identified the only significant risk factor to be older age. There was no difference between the two populations of HD and PD. It is concluded that ED is very prevalent in men beginning dialysis; it should be assessed and treatment be offered.

Sexual function in male patients undergoing treatment for renal failure: a prospective view

INTRODUCTION

Chronic renal failure in males causes wide-ranging disturbances including sexual dysfunction. The percentage and progression of sexual dysfunction in patients entering a dialysis program require further evaluation.

AIM

Our aim was to determine the ongoing effect of standard renal failure treatment on sexual function.

METHODS

The sexual function was assessed prospectively, upon initiation of dialysis and every 10-12 months while on dialysis or after kidney transplantation. Participants were adult males with sexual partners.

MAIN OUTCOME MEASURE

The semiquantitative standard International Index of Erectile Function questionnaire was used initially as a baseline and compared with all subsequent follow-up measures.

RESULTS

Fifty-two patients fulfilled the eligibility criteria and completed the questionnaire. Of the 52 subjects, 25 were on hemodialysis and 27 were on peritoneal dialysis. Only 17.3% of participants were potent upon entry into the study. Of the rest, 71% was classified as suffering from severe erectile dysfunction (ED). Sexual desire appeared less affected when compared with other domains. Of the study participants, 67% expressed an interest in treatment for ED, but only 12% had ever received any such therapy. Follow-up ranged from 10 months to 48 months. After excluding kidney-transplanted patients, ED scores on entry and at four subsequent reassessments were almost identical and showed no significant statistical differences. Patients showed significant improvement in ED score after kidney transplantation, with scores remaining high for 20-36 months of follow-up, compared with pre-transplantation.

CONCLUSIONS

This prospective study suggests that dialysis does not benefit sexual function, although a benefit was seen in a subset of men undergoing renal transplantation. We conclude that sexual function in men beginning dialysis should be assessed, and treatment for ED should be offered if appropriate.

Erectile dysfunction in patients with chronic renal failure

OBJECTIVE

Determine the prevalence of erectile dysfunction in patients undergoing hemodialysis.

MATERIALS AND METHODS

This cross-sectional study was carried out to determine the prevalence of erectile dysfunction in a population of 58 patients in hemodialysis program. Erectile dysfunction was assessed by using the International Index of Erectile Function (IIEF). Information on demographic data, renal failure, comorbidities, laboratory tests and search for medical treatment for erectile dysfunction by means of interviews and researches in medical charts was obtained. Student t test was utilized to compare the laboratory results between group of patients with and without erectile dysfunction. The chi-square test was utilized to compare the comorbidities and the characteristics of the population studied between the groups of patients with and without erectile dysfunction. The significance level considered was 5%.

RESULTS

Mean patient age was 50.2 +/- 14.6 years and the time of hemodialysis was 30.4 +/- 28.4 months. The prevalence of erectile dysfunction was 60.3%. A progressive increase respecting the age was reported. In patients younger than 50 years, this prevalence reached 31.4% and in patients older than 50 years, this prevalence reached 68.6%. With respect to the comorbidities, hypertensive patients prevailed with 94.8% of the total, whilst diabetic patients represented 24.9%. However only the association between diabetes and erectile dysfunction was significant. Patients with erectile dysfunction presented significantly lower values for serum creatinine and Kt/V. There was no variation between the groups with reference to calcium, potassium, phosphorus, hematocrit, hemoglobin, pre- and post-dialysis urea values. There was no correlation between erectile dysfunction and time of dialysis. Amongst patients with erectile dysfunction, 8.6% sought medical care.

CONCLUSIONS

The prevalence of erectile dysfunction in patients in hemodialysis program was of 60.3%. Age, diabetes and hemodialysis characteristics are associated to higher incidence of erectile dysfunction.

Sexual dysfunction in peritoneal dialysis patients

BACKGROUND/AIMS

Sexual dysfunction in patients undergoing peritoneal dialysis (PD) is highly prevalent, but studies addressing this issue are scarce. This cross-sectional study aims to evaluate sexual dysfunction and the determinants among PD patients.

METHODS

All chronic PD patients in 8 PD centers were asked to complete a self-reported questionnaire - the International Index of Erectile Function (IIEF) for men and the Index of Female Sexual Function (IFSF) for women - so that sexual function could be assessed. They also answered the Beck Depression Inventory (BDI) to measure depressive symptoms.

RESULTS

Among 294 patients invited for study, 54 men (mean age 48.8 +/- 10.8 years) and 45 women (mean age 43.6 +/- 7.4 years) were willing to and completed the sexual function questionnaires. The median IIEF score in the men was 56.25. The prevalence of erectile dysfunction, identified by the score in erectile domain of IIEF <or=25, was 51.9%. Older age and higher fasting glucose levels were independently associated with a decreased IIEF score. In women, IFSF score (with a median 27) was significant lower than in healthy peri- or postmenopausal control women. Factors of higher BDI score, receiving automated PD, and older age independently associated with a decreased IFSF score.

CONCLUSIONS

Sexual dysfunction is clinically relevant and multi-dimensional among PD patients. Gender differences exist in the attributing factors of sexual functioning. These warrant more awareness and investigation in the global health care of dialysis patients.

Does Renal Transplantation Improve Erectile Dysfunction in Hemodialysed Patients? What is the Role of Associated Factors?

OBJECTIVE

To assess the effect of successful renal transplantation on improvement of erectile function in hemodialysis (HD) patients and the relationship between the degree of patient response and other factors.

MATERIALS AND METHODS

From September 2002 to November 2005, erectile function of 64 patients on HD for at least 6 months was evaluated pretransplantation and 6 months posttransplantation by International Index of Erectile Function, version 5 (IIEF-5). Sixty four age-matched persons without renal impairment were enrolled as control group to compare erectile dysfunction (ED) prevalence with the HD group. We evaluated duration of HD, age, and site of arterial anastomosis. In an attempt to find predictors of improvement of ED, after kidney transplantation, we performed linear regression analysis with a backward method.

RESULTS

The prevalence of ED in HD patients was 87.5%. Although there were some differences in the prevalence of ED between patients older versus younger than 50 years, the difference was not statistically significant. There was no relationship between the duration of dialysis and the severity of ED in HD group. Compared to the pretransplant IIEF-5 score (13.59), there was significant improvement (19.16). In an attempt to find predictors of ED improvement, we used a linear regression analysis with backward method. Pretransplant IIEF-5 score, age at the time of transplant, and anastomosis to the common iliac artery showed significant associations with improvement, but the duration of dialysis and anastomosis to internal iliac or external iliac artery did not.

CONCLUSION

The incidence of ED among hemodialyzed patients is high. Kidney transplantation is the key treatment for this complaint. ED has a major negative impact on the quality of life and family relations. Its treatment is associated with improvement of psychogenic factors. ED is a sensitive topic and many patients will not spontaneously discuss it with their physician, so better to include potency evaluation in posttransplantation list evaluations.