Therapy Insight: sexual dysfunction in patients with chronic kidney disease

Effect of kidney transplantation on sexual dysfunction in patients with end stage renal disease: A systematic review

BACKGROUND

End-stage renal disease (ESRD) is associated with a multitude of physical, psychological, and social health challenges, including a profound impact on sexual and reproductive health. Among males with ESRD, erectile dysfunction (ED) is highly prevalent due to factors such as underlying comorbidities, including diabetes and hypertension, and the physiological effects of long-term dialysis. Kidney transplantation (KTx) has been proposed as a potential intervention to mitigate the effects of ED by restoring renal function and improving hormonal balance. However, the evidence surrounding the effectiveness of KTx in improving sexual function, specifically erectile function (EF), remains inconclusive. This systematic review and meta-analysis aim to evaluate the effects of KTx on sexual dysfunction (SexDys), particularly ED, in male ESRD patients.

AIM

To evaluate the benefits and potential harms of KTx compared to other forms of renal replacement therapy in improving EF in adult males with ESRD, assessed using the international index of EF (IIEF), to survey the prevalence of SexDys in this population, and to assess the correlation between various factors and SexDys through regression analysis.

METHODS

A systematic search of PubMed, EMBASE, Cochrane Library, Scopus, ClinicalTrials.gov, and Google Scholar was conducted, following the PRISMA 2020 guidelines. Prospective and retrospective cohort studies, as well as cross-sectional studies assessing EF pre- and post-transplantation, were included. These studies used validated tools such as the IIEF to measure EF. Meta-analyses were performed using a random-effects model to estimate standardized mean differences (SMD) and hazard ratios (HR) with 95% confidence intervals (CI). Heterogeneity was assessed using the I² statistic, and publication bias was evaluated with a funnel plot and the Egger’s test.

RESULTS

A total of 2419 studies were identified, with 362 abstracts screened and 193 full-text articles reviewed. Ultimately, 11 studies were included for qualitative analysis and 7 for quantitative synthesis. The random effects model for SMD yielded a combined estimate of 0.43 (95%CI: -0.20-1.07), indicating a small but non-significant improvement in EF post-transplantation. The heterogeneity across studies was substantial (I² = 90%), reflecting significant variability in outcomes. Subgroup analysis showed greater improvements in EF among living-donor transplant recipients compared to those receiving organs from deceased donors. Despite this trend, the overall result for changes in EF was not statistically significant (P = 0.15). Additionally, the combined HR from the meta-analysis was 2.87 (95%CI: 1.76-4.69), suggesting that KTx significantly increases the likelihood of improved EF, though variability between studies persisted (I² = 63%).

CONCLUSION

While KTx offers some promise for improving EF in male ESRD patients, the overall evidence remains inconclusive due to high heterogeneity between studies and a lack of statistical significance in the combined results. Despite this, individual studies suggest that KTx may lead to significant improvements in EF for certain subgroups, particularly living-donor recipients. Future research should focus on larger, well-designed cohort studies with standardized outcome measures to provide more definitive conclusions. Addressing SexDys as part of routine care for ESRD patients undergoing KTx is crucial to improving their overall quality of life. However, adjunct therapies such as phosphodiesterase type 5 inhibitors may be necessary for those who do not experience adequate improvements post-transplantation.

CKD in reproductive-aged women: a call for early nephrology referral and multidisciplinary care

Chronic Kidney Disease (CKD) affects millions globally, with a notable impact on biological females of reproductive age. This population faces specific issues such as fertility concerns, complex contraceptive decisions, and complications related to pregnancy that can exacerbate CKD. Given the increasing prevalence of CKD among young men and women owing to rising rates of hypertension, obesity, and diabetes, there is a need for early and tailored interventions among women of childbearing age. Current Kidney Disease Improving Global Outcomes (KDIGO) guidelines suggest nephrology referral primarily for advanced CKD stages or significant proteinuria. However, women at any CKD stage may face complex pregnancy-related decisions and increased risks that are not adequately addressed by these guidelines, warranting early specialty care. This review explores the distinct needs of women of reproductive age with CKD, identifies gaps in the existing management framework, and advocates for earlier and more comprehensive nephrology involvement. By focusing on preconception planning, risk factor management, adverse pregnancy outcomes, and existing disparities in care, this review seeks to improve understanding of the needs of women of reproductive age with CKD and calls for a shift towards more proactive, nephrology-driven care.

Comparing Western and traditional Chinese medicine for male sexual dysfunction: can Klotho represent a silk road?

Traditional Chinese medicine (TCM) and Western Medicine both have shown efficacy in treating male sexual dysfunction (MSD). The aim of this perspective paper is to discuss a possible link between Western medicine and TCM in the MSD field as represented by the entity of Klotho. Klotho is a recently discovered protein, mainly expressed in the kidney, encoded by the anti-aging gene klotho. Not only is Klotho significantly correlated with the development and progression of kidney diseases and their complications, but increasing evidence indicates that it is also closely related to MSD. A comprehensive search within PubMed database was performed to retrieve available evidence on Klotho's roles, particularly in kidney and in MSD. Indeed, in the TCM theory, the concept of the "kidney" is entirely different from the Western medicine: it is closely related to metabolism and to the reproductive, nervous, endocrine systems, being more than just a urinary organ. According to the "Kidney storing essence (jīng) and governing reproduction" (KSEGR) theory, a cornerstone in TCM, the treatment of MSD mainly consists of restoring the kidney's function. Signs of decreasing kidney essence show a consistent similarity to deficiencies of Klotho, also for what regards the male sexual function. Based on the current evidence, Klotho may represent a potential biological indicator for sexual desire and sexual function and a kind of new scientific Silk Road between TCM and Western medicine for MSD; nevertheless, there is a need to conduct further high-quality research to prove this hypothesis.

Better renal replacement therapy to improve sexual function in female patients with end-stage renal disease: A cross-sectional study

Background

Sexual dysfunction is commonly observed in patients with end-stage renal disease (ESRD). Sexual dysfunction in correlation with ESRD is associated with physiological and psychological problems resulting in low sexual desire, arousal, difficulties in achieving orgasm, and pain during intercourse. Studies on female sexual dysfunction (FSD) in correlation with renal replacement therapy are limited, and previous studies reporting contradictive results have indicated that the best modality for providing better outcomes (especially on FSD) remains unclear. Thus, this study aimed to compare the sexual function between female patients with ESRD who were on continuous ambulatory peritoneal dialysis (CAPD) and those on hemodialysis (HD).

Materials and methods

This study enrolled female patients who were randomly selected from the urology and renal division of the Internal Medicine Outpatient Clinic of our hospital from January 2020 to August 2021 and divided into the following groups: predialysis, HD, CAPD, and control groups. The participants were asked to fill out the Female Sexual Function Index (FSFI) questionnaires, and their data were recorded and analyzed using GraphPad Prism 9.0.0.

Results

Of the 280 patients, 200 female patients were included in this study. The rate of FSD (cutoff: 26.55) was 42% in the control group, 72% in the predialysis group, 62% in the CAPD group, and 66% the in HD group. The control group had a higher mean score in all parameters (p < 0.05). The total FSFI mean score indicated no significant difference (p > 0.05) between the patients on HD and those on CAPD; the mean of each point was almost identical except for satisfaction, which was higher among patients on CAPD (p < 0.05). Significant differences in the components of desire, arousal, orgasm, and satisfaction were observed between the groups.

Conclusions

Patients on CAPD had better FSFI scores than the female patients with ESRD who were on HD, and the scores of both groups of patients were better than those of the predialysis group.

Exploring Symptom Clusters in Chinese Patients with Diabetic Kidney Disease: A Network Analysis

Purpose

The research on symptom management in patients with diabetic kidney disease (DKD) has shifted from separate symptoms to symptom clusters and networks recently. This study aimed to evaluate the unpleasant symptoms of DKD patients, and to investigate how these symptom clusters could affect patients.

Methods

408 DKD patients were recruited in this cross-sectional study. The symptoms of DKD patients were measured using the modified Dialysis Symptom Index. Network analysis was employed to evaluate the symptom network and the characteristics of individual nodes, while factor analysis was utilized to identify symptom clusters.

Results

Blurred vision was the most prevalent symptom among DKD patients. The symptoms identified as the most distressing, severe, and frequent were light headache or dizziness, arteriovenous fistula/catheterization pain, and diarrhea, respectively. Five symptom clusters were obtained from factor analysis, and the most central symptom cluster in the entire symptom network was sexual dysfunction.

Conclusion

This study identified five symptom clusters in Chinese DKD patients, with sexual dysfunction emerging as the most central cluster. These findings carry significant clinical implications, underscoring the necessity of assessing symptom clusters and their associations to enhance symptom management in DKD patients. Further research is essential to elucidate the underlying mechanisms of symptoms and to clarify the associations among symptoms in DKD patients across different disease trajectories or treatment modalities.

Female Infertility in Chronic Kidney Disease

This review summarises the current literature regarding infertility in women with chronic kidney disease (CKD), describing the epidemiology, pathophysiology, investigations, and management options. The pathophysiology is multifactorial, with proposed mechanisms including disruption of the hypothalamus-pituitary-ovarian axis, chronic inflammation, oxidative stress, psychological factors, and gonadotoxic effects of medications such as cyclophosphamide. Diagnostic investigations in CKD patients seeking to conceive should be considered earlier than in the healthy population. Investigations should include hormonal profiling, including markers such as Anti-Mullerian Hormone and imaging such as ultrasound, to evaluate ovarian reserve and identify gynaecology pathology. Treatment options for infertility in CKD patients include GnRH agonists to preserve ovarian function during cyclophosphamide treatment, as well as assisted reproductive technologies including in vitro fertilisation and ovulation induction. However, these treatments must be tailored to the individual's health status, comorbidities, fertility requirements, and CKD stage. In conclusion, fertility is an important consideration for women with CKD, necessitating early investigation and tailored management. Early discussions regarding fertility are important in order to understand patients' family planning and allow for prompt referral to fertility services. While challenges exist, ongoing research aims to clarify the underlying mechanism and optimise treatment strategies, which are crucial for improving quality of life and overall health outcomes.

Sexual well-being and fertility in male renal transplant recipients: A study in a tertiary care centre

INTRODUCTION

Sexual dysfunction is a common problem among chronic kidney disease (CKD) patients. The uraemia, comorbid conditions, hormonal disturbances, autonomic neuropathy, side effects of medication and psycho-social factors contribute to sexual dysfunction. These factors also affect fertility of CKD patients. It starts early in CKD and gradually deteriorates with time. Renal transplant corrects most of the issues and leads to improvement of sexual function which ultimately leads to improved fertility outcomes.

METHODS

It was a cross sectional study performed in a single institution including 135 male renal transplant recipients. A questionnaire was used to evaluate the socio-economic status, fertility and developmental condition of the off-springs. The International index of erectile dysfunction (IIEF) was used for assessment of sexual well-being of the patient. The data were statistically analysed by SPSS 25.0 version.

RESULTS

The mean age at transplant was 40.9 ± 9.9 years and the duration of haemodialysis received 13.6 ± 7.43 months. Among 135 recipients 63 (46.67%) desired but only 49 were successful to father a child. Upper middle class being the largest group to receive renal transplant also had the highest fertility rate in our study. The children born had no development anomaly. Sexual function improved in 85 patients, worsened in 15 and remain unchanged among 35 patients after renal transplant. Overall there was significant improvement in all five parameters of IIEF.

CONCLUSION

Renal transplant corrects most of the metabolic abnormality as well gives a psychological boost to the CKD patients. These lead to improvement of sexual functions which in turn improves the fertility in renal transplant recipients. But the overall fertility rate among the male renal transplant recipients was comparable to the general population.

Development and application of a chronic kidney disease-specific health literacy, knowledge and disease awareness assessment tool for patients with chronic kidney disease in Taiwan

OBJECTIVES

This study aims to develop an assessment tool for health literacy and knowledge specific to chronic kidney disease (CKD) for use in examining the associations between health literacy, disease-specific knowledge and disease awareness among patients with CKD in Taiwan.

DESIGN

An assessment tool in Mandarin and Taiwanese was developed based on patient input, panel discussions with experts and a literature review, and checked for validity and reliability in a pilot test. Formal data were collected through population-based sampling with a set quota according to region and hospital accreditation level. Cross-sectional data were collected to confirm the reliability and validity of the assessment tool. Levels of health literacy, disease knowledge, and disease awareness were then reported and analysed.

SETTING

Sample hospitals included 10 medical centres, 18 regional hospitals and 15 local hospitals in Taiwan. Researchers were granted Internal Review Board approval and obtained agreement to collect data in all study settings.

PARTICIPANTS

Patients at least 20 years old who had been diagnosed with CKD of any stage were eligible to participate. The formal assessment collected 1155 valid questionnaires, yielding an 87.3% response rate. The mean age of participants was 67.48 years (SD=12.87, range 22-98), while 484 (41.95%) were female and 78% were aware they had CKD.

RESULTS

The self-devised instrument proved to have excellent reliability and validity. Use of the instrument in the main study showed that CKD-specific health literacy was significantly associated with age (β=-0.33, p<0.00), educational attainment and disease awareness (β=0.13, p<0.00). CKD-specific knowledge was also significantly associated with age (β=-0.18, p<0.00), educational attainment and disease awareness (β=0.19, p<0.00).

CONCLUSIONS

This CKD-specific health literacy and knowledge assessment tool developed for Mandarin and Taiwanese-speaking patients is reliable and well validated. Patients with CKD who are aware of and understand their disease performed better in the assessment.

Maternal and fetal outcomes of pregnancy in chronic kidney disease: diagnostic challenges, surveillance and treatment throughout the spectrum of kidney disease

Pregnancy requires several physiological adaptations from the maternal organism, including modifications in the glomerular filtration rate and renal excretion of several products. Chronic kidney disease (CKD) can negatively affect these modifications and consequently is associated with several adverse maternal and fetal adverse outcomes (gestational hypertension, progression of renal disease, pre-eclampsia, fetal growth restriction, and preterm delivery). A multidisciplinary vigilance of these pregnancies is essential in order to avoid and/or control the harmful effects associated with this pathology. Dialysis and transplantation can decrease the risks of maternal and fetal complications, nonetheless, the rates of complications remain high comparing with a normal pregnancy. Several recent developments in this area have improved quality and efficacy of treatment of pregnant women with CKD. This article summarizes the most recent literature about CKD and pregnancy.

Predominant Factors Affecting Sexual Dysfunction on Patients with Continuous Ambulatory Peritoneal Dialysis

BACKGROUND: Sexual dysfunction is a complication of terminal kidney failure. The problem of fulfilling sexual needs of men undergoing Continuous Ambulatory Peritoneal Dialysis (CAPD) is influenced by many factors. AIM: This study aims to find out the most dominant factor affecting the sexual dysfunction of men who undergo CAPD. METHODS: The design of this study was cross-sectional analysis with a sample of 70 men CAPD patients using a purposive sampling technique from February to May 2020. Data collection was carried out offline and online by filling in the questionnaire sheets for respondent characteristics, International Index of Erectile Function, and looking at laboratory result. RESULTS: The results showed there was a correlation between age (p=0.0024), plasma urea (p=0.018), and albumin (p=0.001) with sexual dysfunction in male patients using CAPD. There was no significant correlation between length of time undergoing CAPD (p=0.678), fasting glucose (0.051), triglycerides (p=0.536), and cholesterol (p=0.183) with sexual dysfunction in male patients who undergo CAPD. The most dominant factor affecting is albumin, where patients who have albumin levels < 3.5 g/dL are at risk of experiencing sexual dysfunction 9.3 times greater than patients with albumin levels 3.5-5 g/dL after being controlled by age variables. CONCLUSION: The recommendation of this study is protein intake of 1.2-1.5 g/kg body weight with at least 60% of protein with high biological value and evaluation of the ability of care and replacement of CAPD at home.

Sexual dysfunction and activity avoidance in female kidney transplant patients

Sexual dysfunction is common after kidney transplantation and has an adverse effect on patients' quality of life. This paper aims to evaluate the female sexual function, activity avoidance, and kidney function among a convenience sample of patients who had a kidney transplant. A cross-sectional study was conducted that included 250 patients had undergone a kidney transplant procedure >3 months ago, from multiple transplant centers and answered a self-reported sociodemographic questionnaire, the female version of the Arizona Sexual Experience Scale, and the Tampa Scale for Kinesiophobia-13. A correlation was found between sexual function and activity avoidance (r = .361, p < .001, n = 250) as well as between activity avoidance and kidney function (r = .198, p = .012, n = 250). Less education, having no child, post-transplant time for <36 months, and smoking (active and passive) were risk factors for female sexual dysfunction after kidney transplantation. The results suggest that physicians that the importance of recognize the relationship between fear of sexual activity and sexual function and that they should provide patients with more education and guidance on post-transplant sexual behaviors.

Multifaceted Sexual Dysfunction in Dialyzing Men and Women: Pathophysiology, Diagnostics, and Therapeutics

Patient survival continues to increase with the growing quality of dialysis and management of chronic kidney disease (CKD). As such, chronic therapy must include considerations of quality of life (QOL), and this includes the disproportionate prevalence of sexual dysfunction (SD) in this patient population. This review aims to describe the pathophysiological and the psychosocial causes of SD with regard to renal replacement therapy, particularly hemo- and peritoneal dialysis. The differences in its manifestation in men and women are compared, including hormonal imbalances—and therefore fertility, libido, and sexual satisfaction—the experience of depression and anxiety, and QOL. The impact of comorbidities and the iatrogenic causes of SD are described. This review also presents validated scales for screening and diagnosis of SD in CKD patients and outlines novel therapies and strategies for the effective management of SD. Increased prevalence of CKD invariably increases the number of patients with SD, and it is crucial for health care professional teams to become familiar with the clinical tools used to manage this sensitive and under-quantified field. As a known predictor of QOL, sexual function should become a point of focus in the pursuit of patient-centered care, particularly as we seek to achieve as “normal” a life as possible for individuals who receive dialysis.

Sexual Dysfunction in Women With Kidney Disease

Sexual health is inversely associated with estimated glomerular filtration rate and is associated with adverse cardiovascular outcomes, depression, poor self-image, and impaired quality of life. Many women with chronic kidney disease (CKD) and ESKD experience symptoms of sexual dysfunction which is underrecognized secondary to a variety of factors including physicians' discomfort in discussing sexual health, patients' reluctance to bring up sexual health, difficulty in the assessment of sexual health in comparison to men, and the overall lack of well-conducted clinical studies in women. The pathophysiology is not fully understood but likely involves changes in sex hormones throughout the hypothalamic-pituitary-ovarian axis. Proper evaluation of this axis is necessary as treatment is tailored to these findings and can improve outcomes. A comprehensive assessment of sexual dysfunction inclusive of women with varying gender identification and sexual orientation, partnered with recognition and treatment of contributing factors as well as identifying the underlying cause, is paramount. With the lack of studies, particularly in women with CKD, treatment options, in some cases, can be considered unchartered territory. In this article, we will review available evidence on the pathophysiology, clinical manifestations, and treatment for sexual dysfunction in women with CKD and ESKD.

Improving Sexual Function in People With Chronic Kidney Disease: A Narrative Review of an Unmet Need in Nephrology Research

Purpose of review:

Sexual dysfunction occurs commonly in people with chronic kidney disease (CKD) and has been recognized as a research priority. We sought to evaluate the current state of the literature addressing sexual dysfunction in people with CKD and identify barriers and strategies to improve our management of this important symptom.

Sources of information:

OVID Medline and Google Scholar were searched for English, peer-reviewed studies using keywords and terms related to “Chronic Kidney Disease,” “sexuality,” and “sexual dysfunction OR function.”

Methods:

In this narrative review, we describe definitions of sexual dysfunction and contributors exacerbated by CKD, barriers to researching sexual dysfunction in people with CKD, and possible avenues for future research.

Key findings:

Sexual dysfunction is common in people with CKD and results from a combination of kidney disease itself, as well as its associated physical (ie, comorbidities) and nonphysical factors. Barriers to the study of sexual dysfunction in CKD include inconsistent disease definitions, stigma, variable efficacy and safety of established therapies, and evolving gender roles in sexual function. Potential avenues for future research to improve the sexual function in people with CKD may include evaluating the safety and efficacy of established therapies in people with CKD using a variety of observational and interventional study designs, engaging people with CKD and multidisciplinary team members in research, and using implementation science methods to translate what is known about sexual function into clinical practice. Concerted efforts are required to break down barriers and improve sexual function in people with CKD. Patients have identified this as an important research priority, and national networks need to direct efforts to reduce symptom burden.

Limitations:

This narrative review was limited by a paucity of high-quality studies examining sexual dysfunction specifically in people with kidney disease.

Effects of Sexual Function, Social Media Use, and Self-Efficacy on Quality of Life Among Home Parenteral Nutrition Patients

BACKGROUND

Quality of life (QOL) of home parenteral nutrition (HPN) patients is a critical issue for functioning and survival. This study evaluates the roles of sexual function (SF), self-efficacy (SE), and the use of social media (USM) in the QOL of HPN patients.

MATERIALS AND METHODS

The study model investigates the independent variables USM and SF and the dependent variable QOL, and SE is a mediator variable between SF and USM.

RESULTS

We included 203 participants with HPN who completed self-administered, validated questionnaires for QOL, SF, SE, and USM. Statistical analysis included a t-test, Sobel test, bootstrapping method, and Pearson correlations between variances. The mean HPN duration was 10.5 ± 8 years. Results show a significant correlation between QOL scores and SF (P = .001). USM was positively correlated with SE (P = .001). SE as a mediator between USM and SF was supported by significant results in the Sobel test. Patients with a stoma were significantly less sexually active and had lower SE ratings than those without a stoma.

CONCLUSION

Physical changes that affect SE and boost social relationships by allowing emotional support through social networks are important factors for QOL improvement. These findings may guide health professionals in the management of HPN patients.

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.

Network Pharmacology of Yougui Pill Combined with Buzhong Yiqi Decoction for the Treatment of Sexual Dysfunction

Purpose

We aimed to find the possible key targets of Yougui pill and Buzhong Yiqi decoction for the treatment of sexual dysfunction.

Materials and Methods

The composition of Yougui pill combined with Buzhong Yiqi decoction was obtained, and its effective components of medicine were screened using ADME; the component target proteins were predicted and screened based on the TCMSP and BATMAN databases. Target proteins were cross-validated using the CTD database. We performed gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses for target proteins using the Cytoscape plugin ClueGO + CluePedia and the R package clusterProfiler, respectively. Subsequently, protein-protein interaction (PPI) analyses were conducted using the STRING database. Finally, a pharmacological network was constructed.

Results

The pharmacological network contained 89 nodes and 176 relation pairs. Among these nodes, there were 12 for herbal medicines (orange peel, licorice, Eucommia, Aconite, Astragalus, Chinese wolfberry, yam, dodder seed, ginseng, Cornus officinalis, Rehmannia, and Angelica), 9 for chemical components (18-beta-glycyrrhetinic acid, carvacrol, glycyrrhetinic acid, higenamine, nobilin, quercetin, stigmasterol, synephrine, and thymol), 62 for target proteins (e.g., NR3C1, ESR1, PTGS2, CAT, TNF, INS, and TP53), and 6 for pathways (MAPK signaling pathway, proteoglycans in cancer, dopaminergic synapse, thyroid hormone signaling pathway, cAMP signaling pathway, and neuroactive ligand-receptor interaction).

Conclusion

NR3C1, ESR1, PTGS2, CAT, TNF, INS, and TP53 may be important targets for the key active elements in the decoction combining Yougui pill and Buzhong Yiqi. Furthermore, these target proteins are relevant to the treatment of sexual dysfunction, probably via pathways associated with cancer and signal transduction.

Retracted: Sexual Dysfunction in Women with Diabetic Kidney

[This retracts the article DOI: 10.1155/2014/346834.].

Dialysis in pregnancy

Although kidney disease impacts on fertility, increasing numbers of pregnancies are reported in women on dialysis. Despite a trend of increasing live birth rates over recent decades, pregnancies on dialysis remain high risk with increased rates of adverse pregnancy outcomes including pregnancy loss, pre-eclampsia, pre-term delivery, low birth weight and higher levels of neonatal care. This article describes the prevalence of dialysis and pregnancy in women of childbearing age, with relevant information regarding the effects of end-stage renal disease on fertility in women. Pregnancy outcomes for women on dialysis are summarised, including their association with dialysis intensity. A guide to pre-pregnancy counselling, and the management of pregnancy on dialysis is provided. Factors that inform the decision to commence dialysis in pregnancy are examined. The advantages and disadvantages of peritoneal dialysis in pregnancy are discussed.

Sexual dysfunctions and related variables with sexual function in patients who undergo dialysis for chronic renal failure

AIMS AND OBJECTIVES

To evaluate personality characteristics and psychological symptoms believed to have an effect on the sexual functions and performances of patients undergoing dialysis treatment.

BACKGROUND

Chronic renal failure is a life-threatening condition which can often have a poor prognosis. The loss of vital kidney function and other complications can affect almost all age groups.

DESIGN

A quantitative descriptive study.

METHODS

The study sample included 225 patients selected randomly from patients who have undergone dialysis treatment for at least 3 months at a dialysis centre in a university hospital. In this study, the Golombok Rust Inventory of Sexual Satisfaction (GRISS), the Eysenck Personality Inventory (EPI) and the Brief Symptom Inventory (BSI) were used.

RESULTS

In the correlation test, made to investigate the relation between the patients' sexual satisfaction and their personalities, a significant positive relation was found between the communication subscale of the GRISS and the Lie dimension of the EPI, and a significant negative relation was found between the Communication subscale of the GRISS and the Lie dimension of the EPI, and between the Vaginismus and Orgasm subscales of the GRISS and the Extroversion dimension of the EPI.

CONCLUSION

Results showed that sexual problems, in the areas of nonsensuality, anorgasmia, avoidance and communication, are associated with extroversion and psychological symptoms.

RELEVANCE TO CLINICAL PRACTICE

Sexual health and the psychological well-being of patients with renal failure is an important issue that should be considered in nursing practice. Nurses should take the psychological problems of patients and their relations with partners into account and consider these problems in a holistic manner within the framework of nursing practice. They would then be able to play an effective role in intervening at an early stage and would be better equipped to help and control the psychological and sexual problems that some patients may experience.

Sexual Dysfunction Is Associated with Depression and Anxiety in Patients with Predialytic Chronic Kidney Disease

Objective

We aimed to determine the prevalence of sexual dysfunction and clarify the relationship between sexual dysfunction and depressive mood state, drugs, and disease activities in patients with predialytic chronic kidney disease (CKD).

Materials and Methods

In total, 150 patients with CKD who had an estimated glomerular filtration rate of 15-60 mL/min were included; 65 healthy controls were selected. A detailed medical and sexual medical history was taken from individuals in the control and patient groups by applying the Golombok-Rust Inventory of Sexual Satisfaction and Hospital Anxiety and Depression Scale.

Results

Sexual frequency (p=0.027), impotence (p<0.001), and premature ejaculation scores (p<0.001) in male patients and sexual frequency (p=0.004), communication (p=0.004),, satisfaction (p<0.001), avoidance (p=0.008), orgasmic dysfunction (p<0.001), sensuality (p=0.002), and total sexual dysfunction scores (p<0.001) in female patients with CKD were found to be higher compared with the control group. In female patients, the depression scores of patients with stage 3 CKD were found to be higher than those of patients with stage 4 CKD (p=0.028). The avoidance scores of male patients with depression (p=0.006) were high. In contrast, the communication score of female patients with depression was high (p=0.004). It has been detected that the factors that affect the sexual dysfunction score of patients with CKD in males are age (p=0.006), hypertension (p=0.008), anxiety (p=0.003), and depression (p=0.002) and those in female patients are age (p=0.034), anxiety (p<0.001), and depression (p=0.001).

Conclusion

Patients with predialytic CKD substantially have sexual dysfunction. The most important factors that affect sexual dysfunction are age, hypertension, anxiety, and depression.

Gender Difference in the Association of Early- vs. Late-Onset Type 2 Diabetes with Non-Fatal Microvascular Disease in China: A Cross-sectional Study

BACKGROUND

This study aimed to test whether early-onset (defined as <40 years of age) type 2 diabetes mellitus (T2DM) imparted different risks of microvascular disease to Chinese men and women.

METHODS

222,537 Chinese patients with T2DM were recruited in 630 hospitals from 106 cities in 30 provinces of China in 2012 using a cross-sectional design. Logistic regression analysis was performed to obtain odds ratios (ORs) of male vs. female for diabetic retinopathy (DR) and diabetic nephropathy (DN). Additive interaction was used to test whether male gender and early-onset T2DM had interactive effects for DR and DN.

RESULTS

More men than women with T2DM had DN (4.5 vs. 3.0%, P < 0.0001), DR (5.3 vs. 5.1%, P < 0.0001), and microvascular disease (either DN or DR) (8.4 vs. 7.1%, P < 0.0001). After adjustment for age and levels of hospitals, the effect sizes of early-onset T2DM for microvascular disease were higher in men than in women, with a 2.67 [95% confidence intervals (CI): 2.51-2.85] fold risk in men and a 2.53 (95% CI: 2.35-2.72) fold risk in women. The risk effect sizes were greatly attenuated by further adjusting for diabetes durations and other traditional risk factors, with a 1.28 (95% CI: 1.19-1.37) fold risk in men and a 1.07 (95% CI: 0.99-1.16) fold risk in women. After adjustment for diabetes durations and other traditional risk factors, using women with late-onset T2DM as the reference, co-presence of early-onset and male gender significantly enhanced the ORs of either early-onset alone (1.10, 95% CI: 1.03-1.19) or male gender alone (0.96, 95% CI: 0.93-0.99) to 1.32 (95% CI: 1.24-1.41), with significant additive interaction. Kaplan-Meier analysis showed that in early-onset T2DM, DN developed 5 years earlier in men than in women.

CONCLUSION

Early-onset T2DM increased more risk of microvascular complications in Chinese men than in women, most of increased risks being attributable to longer diabetes durations.

Self-Management and Health Care Transition Among Adolescents and Young Adults With Chronic Kidney Disease: Medical and Psychosocial Considerations

Health care transition (HCT) is a process that requires preparation as a continuum from pediatric- to adult-focused services. For adolescents and young adults with chronic or ESRD, this process can be prolonged due to their physical, psychological, family, or ecological factors. HCT preparation is a matter of patient safety and patient rights as the consequences of poor preparation at the time of transfer to adult-focused services are great, including rejection of organs, disease relapse, or even death. We present a case to illustrate important points of HCT preparation, with suggestions for intervention by the interdisciplinary team members who serve (and will serve) these survivors of pediatric-onset health conditions. To monitor the HCT process, yearly measurements of skill mastery need to take place guide interventions.

The Discussion of Sexual Dysfunction Before and After Kidney Transplantation From the Perspective of the Renal Transplant Surgeon

INTRODUCTION

Sexual dysfunction (SD) is a common problem in chronic kidney disease (CKD) and endures in 50% of patients after kidney transplantation (KTx), diminishing patients' expectations of life after KTx. Unfortunately, SD is often ignored by renal care providers. Research questions as part of a research project among all renal care providers, transplant surgeons' perspectives were obtained on sexual health care for KTx recipients, including their opinion on who should be accountable for this care. In addition, surgeons' practice and knowledge regarding SD were evaluated.

DESIGN

A 39-item questionnaire was sent to all Dutch surgeons and residents specialized in KTx (n = 47).

RESULTS

Response was 63.8%. None of the respondents discussed SD with their patients, before or after surgery. Most important barrier was that surgeons do not feel accountable for it (73.9%); 91.7% thought this accountability should lie with the nephrologist. Another barrier was insufficient knowledge (39.1%). In 75% of the respondents, (almost) no knowledge regarding SD was present and 87.5% noticed education on SD was insufficient during residence training.

DISCUSSION

Dutch renal transplant surgeons rarely discuss SD with their patients with CKD, as they do not feel accountable for it; this accountability was appointed to the nephrologist. Knowledge and education regarding SD were found insufficient in enabling surgeons and for some it reflects in barriers toward discussing SD. Results emphasize that accountability for providing sexual health care to patients with CKD should lie elsewhere; however, surgeons could briefly provide information on sexual health after KTx, so unfulfilled expectations may be prevented.

The prevalence and correlates of low sexual functioning in women on hemodialysis: A multinational, cross-sectional study

Sexual dysfunction may affect 80% of women in hemodialysis. However the specific patterns and clinical correlates of sexual functioning remain poorly described. The aim of this study was to assess prevalence and correlates of the individual domains of sexual functioning in women treated with hemodialysis. We recruited, into this multinational cross-sectional study, women treated with long-term hemodialysis (Collaborative Working Group on Depression and Sexual dysfunction in Hemodialysis study). Self-reported domains of sexual functioning were assessed by the Female Sexual Function Index, which is routinely administered within the network of dialysis patients followed by the working group. Lower scores represented lower sexual functioning. Socio-demographic and clinical correlates of each domain of sexual functioning were identified by stepwise multivariable linear regression. Sensitivity analyses were restricted to women who reported being sexually active. We found that of 1309 enrolled women, 659 (50.3%) provided complete responses to FSFI survey questions and 232 (35%) reported being sexually active. Overall, most respondents reported either no sexual activity or low sexual functioning in all measured domains (orgasm 75.1%; arousal 64.0%; lubrication 63.3%; pain 60.7%; satisfaction 60.1%; sexual desire 58.0%). Respondents who were waitlisted for a kidney transplant reported scores with higher sexual functioning, while older respondents reported scores with lower functioning. The presence of depression was associated with worse lubrication and pain scores [mean difference for depressed versus non-depressed women (95% CI) -0.42 (-0.73 to -0.11), -0.53 (-0.89 to -0.16), respectively] while women who had experienced a previous cardiovascular event reported higher pain scores [-0.77 (-1.40- to -0.13)]. In conclusion, women in hemodialysis reported scores consistent with marked low sexual functioning across a range of domains; the low functioning appeared to be associated with comorbidity.

Blood Pressure, Sexual Activity, and Dysfunction in Women With Hypertension: Baseline Findings From the Systolic Blood Pressure Intervention Trial (SPRINT)

INTRODUCTION

Sexual function, an important component of quality of life, is gaining increased research and clinical attention in older women with hypertension.

AIM

To assess the association between systolic blood pressure (SBP) and other variables, and sexual activity and sexual dysfunction in hypertensive women.

METHODS

Baseline analysis of 635 women participants of a larger randomized clinical trial of 9361 men and women.

MAIN OUTCOME MEASURES

Self-reported sexual activity (yes/no), and sexual function using the Female Sexual Function Inventory (FSFI).

RESULTS

452 participants (71.2%) reported having no sexual activity during the previous 4 weeks. The mean (SD) FSFI score for sexually active participants was 25.3 (6.0), and 52.6% of the sample reported a FSFI score ≤26.55 designating sexual dysfunction. In logistic regression models, SBP was not significantly associated with sexual activity (AOR = 1.002; P > .05). Older age (AOR = 0.95, P < .05), and lower education (AOR for < high school vs college degree = 0.29, P < .05) were associated with lower odds of being sexually active, as was living alone versus living with others (AOR = 0.56, P < .05). Higher weekly alcohol consumption was associated with increased odds of being sexually active (AOR = 1.39; P < .05). In logistic regression models among sexually active participants, SBP was not associated with sexual dysfunction (AOR = 1.01; P > .05). Higher depressive symptoms from the Patient Health Questionnaire-9 (PHQ-9) was associated with higher odds of sexual dysfunction (AOR = 1.24, P < .05), as was increased number of physical comorbidities (AOR = 1.25, P < .05). Diuretic use was associated with lower odds of being sexually active in participants with chronic kidney disease (AOR = 0.33, P < .05).

CONCLUSION

Younger age, higher education, living with others, and higher weekly alcohol consumption were significantly associated with higher odds of being sexually active in a sample of middle-aged and older women with hypertension. Increased depressive symptoms and increased physical comorbidities were significantly associated with increased odds of sexual dysfunction. SBP was not significantly associated with sexual activity or sexual dysfunction.

Sexual Function and Testosterone Level in Men With Conservatively Treated Chronic Kidney Disease

Sexual dysfunctions are common, but underrecognized, in patients with chronic kidney disease (CKD) and are inversely associated with the glomerular filtration rate (GFR). Sexual dysfunctions may affect quality of life in males with CKD. The aim of this study was to analyze the relationship among sex hormones, sexual function, and sexual satisfaction in a group of men between 18 and 50 years of age with CKD Stages 1 to 5 not treated with hemodialysis or peritoneal dialysis. Fasting blood samples for hemoglobin, testosterone, prolactin, and luteinizing hormone and questionnaire surveys (Sexual Complaints Screener for Men, International Index of Erectile Function, and Aging Male Symptom scale) were evaluated in 100consecutive men. Higher CKD stage (i.e., lower renal function) had a statistically significant ( p < .01) correlation with lower total testosterone, free testosterone, and hemoglobin levels, and higher luteinizing hormone and prolactin levels. Sexual function/dysfunctions were not significantly associated with CKD stage, even after adjustment for age and serum testosterone. The results indicate that CKD stage is a factor affecting testosterone levels in combination with age in men between 18 and 50 years of age at different stages of CKD but not treated with hemodialysis or peritoneal dialysis. Sexual dysfunctions are common but not strongly correlated to testosterone levels, prolactin levels, and survey (Sexual Complaints Screener for Men, International Index of Erectile Function, and Aging Male Symptom scale) responses in patients with CKD.

Gonadal dysfunction in chronic kidney disease

Sexual dysfunction is a common finding in both men and women with chronic kidney failure. Common disturbances include erectile dysfunction in men, menstrual abnormalities in women, and decreased libido and fertility in both sexes. These abnormalities are primarily organic in nature and are related to uremia as well as the other comorbid conditions that frequently occur in the chronic kidney failure patient. Fatigue and psycho social factors related to the presence of a chronic disease are also contributory factors. Disturbances in the hypothalamic-pituitary-gonadal axis can be detected prior to the need for dialysis but continue to worsen once dialytic therapy is initiated. Impaired gonadal function is prominent in uremic men while the disturbances in the hypothalamic-pituitary axis are more subtle. By contrast, central disturbances are more prominent in uremic women. Therapy is initially directed towards optimizing the delivery of dialysis, correcting anemia with recombinant erythropoietin, and controlling the degree of secondary hyperparathyroidism with vitamin D. For many practicing nephrologists sildenafil has become the first line therapy in the treatment of impotence. In the hypogonadal man whose only complaint is decreased libido, testosterone may be of benefit. Regular gynecologic follow up is required in uremic women to guard against potential complications of unopposed estrogen effect. Uremic women should be advised against pregnancy while on dialysis. Successful transplantation is the most effective means of restoring normal sexual function in both men and women with chronic kidney failure.

Pregnancy in chronic kidney disease and kidney transplantation

Chronic kidney disease (CKD) affects up to 6% of women of childbearing age in high income countries, and is estimated to affect 3% of pregnant women. Advanced renal dysfunction, proteinuria, hypertension, and poorly controlled underlying primary renal disease are all significant risks for adverse maternal, fetal, and renal outcomes. In order to achieve the best outcomes, it is therefore of paramount importance that these pregnancies are planned, where possible, to allow the opportunity to counsel women and their partners in advance and to optimize these risks. These pregnancies should be deemed high risk and they require close antenatal monitoring from an expert multidisciplinary team. We discuss the effect of pregnancy on CKD, and also current guidelines and literature with specific reference to transplantation, autoimmune disease, and medication use in pregnancy. We also discuss the benefits of prepregnancy counseling and give practical recommendations to advise pregnant women with renal disease.

Sexuality and elderly with chronic diseases: A review of the existing literature

Background:

Increased life expectancy and the growing phenomenon of aging can lead to increased burden of chronic diseases (CDs) which adversely affects the overall health of elderly, their sexuality in particular. Sexual life of an aged population is overlooked in many of the societies. In the present narrative review, we aim to assess the impact of CDs on sexual function of elderly people.

Materials and Methods:

We used internet databases including PubMed, EMBASE, ISI Web of Science, Google Scholar, SID, Iran Medex, Magiran, IPPF, and UNFPA without time limit. Ninety-eight out of 174 relevant articles were selected which met the inclusion criteria: those articles were research-based in English or Persian (original or review articles) and textbooks; specified one or more CDs and sexual function of the cases; elderly people over the age of sixty, men and women; and coordination between articles and research goals. We excluded qualitative and case studies. We reported the most related CDs with sexual function in literature review and used the biological and psychological impact of the CDs on sexual function of elderly population based on the conceptual model of Verschuren et al. (2010).

Results:

The results of the studies were classified into the themes including physical, psychological, and cultural and social. Diabetes, cardiovascular, cancerous, and chronic respiratory diseases and also some medications can reduce sexual capacity and desire in particular resulting in negative impact on the quality of elderly sexual life. CDs may influence sexual expressions and responses which adversely affect one's mood and energy so that can cause depression and grief, as well as loss of self-confidence, self-esteem, and self-concept in elderly adults. The factors affecting sexuality of an elderly with CDs include cultural and mythical beliefs about age and illnesses, fear, and embarrass of changed physical appearance. The research conducted among elderly population examining the adverse influence of CDs on aged people's sexual life in general, sexual function and performance, and intimate interaction.

Conclusion:

It is considered that programs on sexual health needs of aged population for the health-care workers can prove beneficial in improving sexual health.

Change in quality of life and one-year mortality risk in maintenance dialysis patients

BACKGROUND

Quality of life (QOL) is an important metric of high-quality dialysis care. QOL is commonly measured by the Short Form 36 Questionnaire (SF-36), which provides two summary scores: a mental component score (MCS) and a physical component score (PCS). Poor QOL is associated with mortality in dialysis patients. Small studies show that changes in QOL also predicts mortality. We investigated whether changes in QOL over time are associated with mortality in a large cohort of maintenance hemodialysis patients.

METHODS

This retrospective study was conducted in 1017 outpatient dialysis facilities. Over 10,000 hemodialysis patients completed two SF-36 surveys. We compared 1-year morality rates in those whose MCS or PCS increased or decreased ±5 vs. those whose did not.

RESULTS

For those who completed two surveys, mean score for PCS was unchanged, whereas MCS increased slightly (48.6 vs. 48.9, p = 0.05). Individual patients, however, showed marked variation. On the second survey, more than half of patients demonstrated a ± 5 point change in the PCS and/or MCS. After multivariate adjustment, a ≥ 5 decrease in MCS was associated with an increase in mortality (HR = 1.33, 95 % CI 1.18, 1.50).

CONCLUSIONS

Clinicians should be aware that many patients experience a significant change in both the MCS and PCS on dialysis. A MCS decrease of ≥5 was associated with increased mortality. More study is needed to determine whether this is a causal relationship. Physicians should evaluate root causes and seek to mitigate declines in QOL whenever possible.

How Can We Improve the Quality of Life of Dialysis Patients?

As medical advances are made in the care of persons with chronic illnesses including those with end-stage renal disease (ESRD), patients are not only experiencing increasing life expectancy but also bearing the burden of illness and treatment for a longer duration of time. With this in mind, it is increasingly important for health care providers to pay close attention to their individual patient's perceptions of their health, fitness, life satisfaction, and well-being. This assessment of Health-Related Quality of Life (HRQOL) also includes an evaluation of the patient's level of satisfaction with treatment, outcome, and health status, also taking into account their perspective on future prospects. In addition to improving patient-provider communication by helping in the identification and prioritization of problems, it is important to note that high HRQOL has been shown to be associated with better medical outcomes, including reduction in hospitalizations and death. In this review, we outline several validated tools that are used to quantitatively measure HRQOL in the ESRD population and incorporate these instruments in a review of specific, evidence-based measures by which we can measurably improve health-related quality of life in dialysis patients.

Menopausal symptoms in women with chronic kidney disease

OBJECTIVE

This study aims to determine whether menopausal symptoms differed between women with chronic kidney disease (CKD) and women without CKD, and whether CKD modified associations of late vasomotor symptoms (VMS) with mortality and/or cardiovascular events.

METHODS

CKD, defined as estimated glomerular filtration rate lower than 60 mL/minute/1.73 m (using the Chronic Kidney Disease Epidemiology Collaboration equation), was determined in 17,891 postmenopausal women, aged 50 to 79 years at baseline, in the multiethnic Women's Health Initiative cohort. Primary outcomes were presence, severity, and timing/duration of VMS (self-reported hot flashes and night sweats) at baseline. We used polytomous logistic regression to test for associations among CKD and four VMS categories (no VMS; early VMS-present before menopause but not at study baseline; late VMS-present only at study baseline; persistent VMS-present before menopause and study baseline) and Cox regression to determine whether CKD modified associations between late VMS and mortality or cardiovascular events.

RESULTS

Women with CKD (1,017 of 17,891; mean estimated glomerular filtration rate, 50.7 mL/min/1.73 m) were more likely to have had menopause before age 45 years (26% vs 23%, P = 0.02) but were less likely to experience VMS (38% vs 46%, P < 0.001) than women without CKD. Women with CKD were not more likely than women without CKD to experience late VMS. Late VMS (hazard ratio, 1.16; 95% CI, 1.04-1.29) and CKD (hazard ratio, 1.74; 95% CI, 1.54-1.97) were each independently associated with increased risk for mortality, but CKD did not modify the association of late VMS with mortality (Pinteraction = 0.53), coronary heart disease (Pinteraction = 0.12), or stroke (Pinteraction = 0.68).

CONCLUSIONS

Women with mild CKD experience earlier menopause and fewer VMS than women without CKD.

Initiation of puberty in mice following decellularized ovary transplant

Clinical interventions to preserve fertility and restore hormone levels in female patients with therapy-induced ovarian failure are insufficient, particularly for pediatric cancer patients. Laparoscopic isolation of cortical ovarian tissue followed by cryopreservation with subsequent autotransplantation has temporarily restored fertility in at least 27 women who survived cancer, and aided in pubertal transition for one pediatric patient. However, reintroducing cancer cells through ovarian transplantation has been a major concern. Decellularization is a process of removing cellular material, while maintaining the organ skeleton of extracellular matrices (ECM). The ECM that remains could be stripped of cancer cells and reseeded with healthy ovarian cells. We tested whether a decellularized ovarian scaffold could be created, recellularized and transplanted to initiate puberty in mice. Bovine and human ovaries were decellularized, and the ovarian skeleton microstructures were characterized. Primary ovarian cells seeded onto decellularized scaffolds produced estradiol in vitro. Moreover, the recellularized grafts initiated puberty in mice that had been ovariectomized, providing data that could be used to drive future human transplants and have broader implications on the bioengineering of other organs with endocrine function.

Sexual dysfunction in women with diabetic kidney

Few studies address alteration of sexual function in women with diabetes and chronic kidney disease (CKD). Quality of life surveys suggest that discussion of sexual function and other reproductive issues are of psychosocial assessment and that education on sexual function in the setting of chronic diseases such as diabetes and CKD is widely needed. Pharmacologic therapy with estrogen/progesterone and androgens along with glycemic control, correction of anemia, ensuring adequate dialysis delivery, and treatment of underlying depression are important. Changes in lifestyle such as smoking cessation, strength training, and aerobic exercises may decrease depression, enhance body image, and have positive impacts on sexuality. Many hormonal abnormalities which occur in women with diabetes and CKD who suffer from chronic anovulation and lack of progesterone secretion may be treated with oral progesterone at the end of each menstrual cycle to restore menstrual cycles. Hypoactive sexual desire disorder (HSDD) is the most common sexual problem reported by women with diabetes and CKD. Sexual function can be assessed in women, using the 9-item Female Sexual Function Index, questionnaire, or 19 items. It is important for nephrologists and physicians to incorporate assessment of sexual function into the routine evaluation protocols.

Depression and sexual dysfunction in chronic kidney disease: a narrative review of the evidence in areas of significant unmet need

People with chronic kidney disease (CKD) have a high symptom burden and experience poorer quality of life than the general population. People with CKD frequently report fatigue, anorexia, pain, sleep disturbance, itching and restless legs. Depression and sexual dysfunction may also be common in CKD, although questions about optimal diagnosis and treatment remain unanswered. People with kidney disease identify lifestyle and the impact of CKD on family and psychosocial supports as key priorities and rate symptoms such as sexual dysfunction and psychological distress as severe. Here, we outline the current state of research underlying depression and sexual dysfunction in this population focusing on prevalence, diagnosis, screening, outcomes and interventions and suggest areas requiring additional specific research.

Sexual functioning in chronic kidney disease: the association with depression and anxiety

Sexual functioning is composed of both physiological and psychological factors among patients with chronic kidney disease (CKD). However, the role of depression and anxiety has not yet been studied extensively. This study aimed to investigate the relation of depressive and anxiety symptoms to sexual functioning among hemodialysis (HD) and peritoneal dialysis patients. A sample of 144 patients was recruited from three general hospitals in the broader area of Athens, consisting of 84 patients undergoing in-center HD and 60 patients in continuous ambulatory peritoneal dialysis. Measurements were conducted with the following instruments: the World Health Organization Quality of Life instrument, the General Health Questionnaire (GHQ-28), the State-Trait Anxiety Inventory (STAI 1/STAI 2), and the Center for Epidemiologic Studies Depression Scale. The results indicated that satisfaction about sexual life had negative association with all the subscales of GHQ-28 questionnaire (somatic symptoms, anxiety/insomnia, social dysfunction, severe depression). Sexual functioning was also related negatively to depression as well as state and trait anxieties. Findings provide evidence that the presence of depressive and anxiety symptoms relates significantly to the negative evaluation of sexual functioning in patients with CKD.

Does radical nephrectomy increase the risk of erectile dysfunction compared with partial nephrectomy? A cohort analysis

Study Type - Therapy (prospective cohort) Level of Evidence 2b What's known on the subject? and What does the study add? Erectile dysfunction (ED) is a form of endothelial dysfunction that is prevalent in patients with chronic kidney disease (CKD). We hypothesized that partial nephrectomy (PN) would limit development of ED compared with radical nephrectomy (RN), primarily due to renal function preservation, and found that patients undergoing RN had significantly higher de novo ED compared with a contemporary, well-matched cohort undergoing PN; in addition to RN, hypertension, CKD and diabetes mellitus were associated with developing ED. To our knowledge, this is the first study demonstrating an increased risk of ED after RN compared with PN.

OBJECTIVES

•  To evaluate prevalence and risk factors for development of erectile dysfunction (ED) in patients who underwent radical nephrectomy (RN) and partial nephrectomy (PN). •  ED is a form of endothelial dysfunction that is prevalent in patients with chronic kidney disease (CKD). PN confers superior renal functional preservation compared with RN; however, the impact on ED is unclear.

METHODS

•  This was a retrospective study of 432 patients (264 RN/168 PN, mean age 58 years, mean follow-up 5.8 years) who underwent surgery for renal tumours between January 1998 and December 2007. •  The primary outcome was rate of de novo ED postoperatively. Secondary outcomes included development of CKD (estimated GFR < 60 mL/min/1.73 m(2) ) and response to phosphodiesterase-5 inhibitors. •  Multivariate analysis was performed to determine risk factors for de novo ED postoperatively.

RESULTS

•  RN and PN groups had similar demographics and comorbidities. •  Tumour size (cm) was larger for RN (RN 7.0 vs PN 3.7, P < 0.001) and more preoperative ED existed in PN vs RN (P= 0.042). No differences were observed for preoperative CKD, hyperlipidaemia and diabetes mellitus. •  Postoperatively, higher rates of de novo ED (29.5% vs 9.5%, P < 0.001) and CKD (33.0% vs 9.8%, P < 0.001) developed in RN vs PN cohorts, respectively. •  Of men with ED, 63% responded to phosphodiesterase inhibitors, without significant difference between the two groups (P= 0.896). •  Multivariate analysis demonstrated de novo ED to be associated with RN (odds ratio [OR] 3.56, P < 0.001), hypertension (OR 2.32, P= 0.014), preoperative (OR 8.77, P < 0.001) and postoperative (OR 2.64, P= 0.001) CKD, and postoperative diabetes mellitus (OR 2.93, P < 0.001).

CONCLUSIONS

•  Patients undergoing RN had significantly higher de novo ED compared with a contemporary, well-matched cohort undergoing PN. In addition to RN, hypertension, CKD and diabetes mellitus were associated with developing ED. •  Further investigation on effects of surgically induced nephron loss on ED is requisite.

Sexual and gonadal dysfunction in chronic kidney disease: Pathophysiology

Sexual and gonadal dysfunction/infertility are quite common in patients with chronic kidney disease. Forty percent of male and 55% of female dialysis patients do not achieve orgasm. The pathophysiology of gonadal dysfunction is multifactorial. It is usually a combination of psychological, physiological, and other comorbid factors. Erectile dysfunction in males is mainly due to arterial factors, venous leakage, psychological factors, neurogenic factors, endocrine factors, and drugs. Sexual dysfunction in females is mainly due to hormonal factors and manifests mainly as menstrual irregularities, amenorrhea, lack of vaginal lubrication, and failure to conceive. Treatment of gonadal dysfunction in chronic kidney disease is multipronged and an exact understanding of underlying pathology is essential in proper management of these patients.