Prevalence and associated risk factors of male erectile dysfunction among patients on hemodialysis and kidney transplant recipients: a cross-sectional survey from Sudan

The Assessment of Male Erectile Dysfunction Characteristics in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis and Hemodialysis Using the International Index of Erectile Function (IIEF-5) Combined with Hospital Anxiety and Depression Scales

Purpose

To determine the differences in mean scores of erectile dysfunctions (EDs) assessed by the International Index of Erectile Function (IIEF-5) questionnaire between patients with chronic kidney disease (CKD) undergoing hemodialysis and patients undergoing continuous ambulatory peritoneal dialysis (CAPD).

Patients and Methods

This is an analytic observational study with a cross-sectional design that was conducted from June to December 2022 at the Urology Center of Haji Adam Malik General Hospital and Rasyida Kidney Specialized Hospital. The sample of this study were male CKD-patients who underwent regular hemodialysis (HD) and who underwent CAPD, and met the inclusion and exclusion criteria. Psychological disorders experienced during therapy session are considered as risk factors and assessed via the Hospital Anxiety and Depression Scale (HADS). These disorders assessment was used to evaluate the severity of the patients' anxiety and depressive symptoms. Statistical data analysis was carried out.

Results

Both groups had HADS-A and HADS-D scores with an average <7, classified as normal anxiety and depression. Most of the patients in the HD group had mild-to-moderate ED (28.6%), while in the CAPD group had mild severity of ED (38.1%). There were no significant differences in severity of ED between patients undergoing HD and CAPD (p > 0.05). However, there was a significant difference in ED scores (IIEF-5) between patients undergoing HD and those with CAPD (p < 0.05), in which patients in the CAPD group had a higher IIEF-5 score. In addition, there was a significant positive correlation with moderate strength (p<0.001; r=0.494) between anxiety disorders and ED disorders in patients undergoing HD and CAPD, whereas there is no significant correlation between depressive disorders and ED conditions (p > 0.05).

Conclusion

There was a significant difference in IIEF-5 scores between patients undergoing HD and CAPD.

Sexual Dysfunction Among Patients With Chronic Kidney Disease

Sexual dysfunction (SD) in patients with chronic kidney disease is common and negatively impacts quality of life. SD is often under-appreciated because of overall low awareness. Diagnosis of SD is subjective, and manifestations can be different among men and women. Causes of SD are multifactorial, including psychological disorders, hormonal imbalances, vascular disorders, neurological disorders, and medication side effects. Non-specific approaches to improving sexual function include addressing underlying psychological disorders, promoting lifestyle modifications, optimizing dialysis care, and facilitating successful kidney transplantation, whereas treatment with phosphodiesterase type 5 inhibitor, hormone replacement, and mechanical devices can be offered to patients with specific indications.

Erectile dysfunction pre and post kidney transplant recipients in Duhok city; cross sectional study

Introduction

Sexual dysfunction is a common problem in patients with chronic kidney disease. Disturbances in sexual function are noticed in early stages of chronic kidney diseases and deteriorate further as renal function declines. This is due to uremic effects, comorbid illness, anemia, hormonal disturbances, autonomic neuropathy, vascular diseases, hyperparathyroidism, hyperprolactinemia, side effects of medications, and psychosocial factors.

Patients and method

This is a cross-sectional study which included 59 male patients who underwent renal transplantation for more than 6 months. The International Index of Erectile Function (IIEF-5) was adopted in our study to record the erectile function.

Results

The mean age was 49.41 years, and the mean number of hemodialysis per month was 5.31. The cause of the chronic kidney disease was diabetes mellitus in 35.59%, glomerulonephritis in 20.34%, and hypertension in 16.95%, other causes were diagnosed in order of decreasing frequency. Most patients developed improvement in the erectile function after transplantation. There was significant correlation with 3 of the elements of the IIFE-5.i.e; penile hardness pre-penetration, Maintaining erection during intercourse, and Difficulty to maintain erection to complete the intercourse (p values 0.015, 0.011, and 0.023) respectively, and the overall improvement after transplantation which showed a p-value of less than 0.031, while there was no significant correlation with Confidence with erection and Satisfaction with intercourse before and after transplantation (p values 0.113 and 0.121) respectively. One of the patients (1.7%) developed severe dysfunction after that.

Conclusion

ED is common sequel of chronic kidney disease. The etiology is multifactorial and may be worsen by advanced age, presence of diabetes mellitus and prolonged duration of hemodialysis. Renal transplantation has a positive impact on sexual function and lead to improvement of erectile dysfunction. Erectile dysfunction that persists after kidney transplantation is usually attributed to multiple preexisting comorbidities.

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Sexual dysfunction is a common problem in patients with chronic kidney disease.

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The etiology of Sexual dysfunction is multifactorial.

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Renal transplantation has a positive impact on sexual function.

The efficacy of low-dose tadalafil in patients undergoing hemodialysis with end-stage renal disease

BACKGROUND

Erectile dysfunction (ED) is a disorder that is frequently observed in people with chronic kidney disease who undergo hemodialysis (HD). In the context of evidence-based medicine, we aimed to investigate the effect of low-dose tadalafil on sexual function in patients undergoing HD.

METHODS

The medical records of 30 males (aged 29-65 years) with end-stage renal disease (ESRD) on a HD program, and who had received 5 mg tadalafil twice weekly, were retrospectively evaluated. Changes in erectile and ejaculatory function were evaluated using the International Erectile Function Index questionnaire, the Erection Hardness Scale (EHS), and the Male Sexual Health Questionnaire (MSHQ).

RESULTS

The mean age of the patients was 47.6 ± 10.1 years, their mean body mass index was 24.3 ± 4.2 kg/m², their mean hemoglobin was 11.9 ± 0.9 g/dL, and their mean creatinine clearance was 5.8 ± 1.1 mL/min. At the third month of treatment, 36.6% of the patients had no ED, 40% had mild ED, 10% had mild-to-moderate ED, and 13.3% had moderate ED. The mean MSHQ scores (p < .05) and the mean EHS scores (p = .001) were significantly improved. There was no significant difference between Beck's Depression Inventory scores (p > .05), but Hamilton anxiety rate scores decreased significantly (p = .001). The quality-of-life score improved throughout the study period (p < .05).

CONCLUSIONS

Tadalafil therapy is an effective therapeutic option in patients with ESRD who undergo HD, not only for the treatment of ED, but also for ejaculatory function, with acceptable adverse effects.

Hyperbranched polyglycerol is superior to glucose for long-term preservation of peritoneal membrane in a rat model of chronic peritoneal dialysis

Background

Replacing glucose with a better biocompatible osmotic agent in peritoneal dialysis (PD) solutions is needed in PD clinic. We previously demonstrated the potential of hyperbranched polyglycerol (HPG) as a replacement for glucose. This study further investigated the long-term effects of chronic exposure to HPG as compared to a glucose-based conventional PD solution on peritoneal membrane (PM) structure and function in rats.

Methods

Adult male Wistar rats received once-daily intraperitoneal injection of 10 mL of HPG solution (1 kDa, HPG 6%) compared to Physioneal™ 40 (PYS, glucose 2.27%) or electrolyte solution (Control) for 3 months. The overall health conditions were determined by blood chemistry analysis. The PM function was determined by ultrafiltration, and its injury by histological and transcriptome-based pathway analyses.

Results

Here, we showed that there was no difference in the blood chemistry between rats receiving the HPG and the Control, while PYS increased serum alkaline phosphatase, globulin and creatinine and decreased serum albumin. Unlike PYS, HPG did not significantly attenuate PM function, which was associated with smaller change in both the structure and the angiogenesis of the PM and less cells expressing vascular endothelial growth factor, α-smooth muscle actin and MAC387 (macrophage marker). The pathway analysis revealed that there were more inflammatory signaling pathways functioning in the PM of PYS group than those of HPG or Control, which included the signaling for cytokine production in both macrophages and T cells, interleukin (IL)-6, IL-10, Toll-like receptors, triggering receptor expressed on myeloid cells 1 and high mobility group box 1.

Conclusions

The results from this experimental study indicate the superiority of HPG to glucose in the preservation of the peritoneum function and structure during the long-term PD treatment, suggesting the potential of HPG as a novel osmotic agent for PD.

Electronic supplementary material

The online version of this article (doi:10.1186/s12967-016-1098-z) contains supplementary material, which is available to authorized users.

The Impact of Hemodialysis on Sexual Function in Male Patients using the International Index of Erectile Function Questionnaire (IIEF)

Introduction

Routine hemodialysis is one of the preferred treatment methods in patients with chronic kidney disease. It seems that routine hemodialysis can be effective in improving sexual function in these patients. This study aimed to determine the effect of routine dialysis sessions over a six-month period on the status of sexual function in men with chronic renal failure using the International Index of Erectile Function (IIEF) questionnaire.

Methods

The cross-sectional study was conducted from November 2015 to November 2016 on patients with chronic renal failure who were first-time candidates for routine hemodialysis and who were referred to Imam Reza Hospital of Mashhad. All of the patients completed the IIEF questionnaire before their first hemodialysis. Afterwards, all of the patients underwent routine dialysis sessions over a six-month period and completed the IIEF questionnaire again at the end of the sixth month. The prevalence of sexual dysfunction was assessed before and after hemodialysis. The scores on the two IIEF questionnaires were compared according to five domains, i.e., erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction. The comparisons were done before and after hemodialysis using the paired-samples t-test. Statistical analyses were performed using SPSS version 19.

Results

The study included 30 men with a mean age of 40.2 ± 8.2. The prevalence of sexual dysfunctions in the order of their frequency was as follows: intercourse satisfaction (100%), overall satisfaction (100%), sexual desire (96.7%), orgasmic function (93.3%), and erectile function (90%). After six months of treatment with hemodialysis, the ratings of all areas of sexual dysfunction were improved significantly (p-value = 0.00 for all domains).

Conclusion

According to the results of this study, it seems that a six-month course of hemodialysis can improve erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction in patients with chronic kidney disease.