Is erectile dysfunction an early clinical symptom of chronic kidney disease?

Understanding nurses' perceptions of sexual health and function in people requiring haemodialysis

BACKGROUND

Sexual dysfunction is common for adults receiving chronic haemodialysis; however, renal nurses seldom discuss this topic with patients.

OBJECTIVES

This study aimed to identify renal nurses' attitudes towards providing sexual healthcare and to determine their confidence in discussing sexual dysfunction with adults who are receiving haemodialysis.

DESIGN

An online cross-sectional study.

PARTICIPANTS

Renal nurses across Australia and New Zealand (n = 65) who were members of the Renal Society of Australasia provided direct care to adults receiving haemodialysis.

MEASUREMENTS

Two questionnaires measuring (1) the frequency of sexual health discussions, levels of knowledge and competence, barriers to discussing sexual dysfunction and views on accountability (Van Ek survey) and (2) communication, practical knowledge, and attitude (sexual health educator for professionals scale) were used. Demographic characteristics were also collected.

RESULTS

Most participants were females (60%) with postgraduate qualifications (61.4%). The average nephrology nursing experience was 13.10 ± 9.14 years. Most renal nurses identified as having positive attitudes (77.2%) about providing sexual healthcare and were confident in communicating with patients about sexual concerns (42.9%), although many nurses (64.35%) rarely did so. Less than one-half (48.6%) indicated feeling competent to discuss sexual dysfunction, and less than one-third (30%) had sufficient knowledge about sexual dysfunction. Barriers were lack of practical training (74.2%) and insufficient time (57.1%). Younger nurses (≤45 years old) and male nurses were significantly more confident in discussing sexual health matters.

CONCLUSIONS

Overall, renal nurses had positive attitudes towards discussing sexual health concerns with patients however they rarely did so.

Correlation between Serum Levels of Nitric Oxide and Adropin and Erectile Dysfunction in Males with Nonalcoholic Fatty Liver Disease: An Observational Study

The current study aimed to evaluate the serum levels of nitric oxide (NO) and adropin in males with non-alcoholic fatty liver disease (NAFLD) induced erectile dysfunction (ED) and NAFLD patients without ED and controls. The current study selected 165 participants from the hepatology department from November 2021 to November 2022. The patients were either suffering from NAFLD with normal liver functions or non-alcoholic steatohepatitis with abnormal liver functions. They were diagnosed by abdominal ultrasonography. Participants were evaluated using the validated Arabic version of the International Index of Erectile Function (ArIIEF-5), the Arabic form of the Generalized Anxiety Disorder-7 (GAD-7) questionnaire and the Patient Health Questionnaire-9 (PHQ-9). Noteworthy, there were significant positive correlations between ArIIEF-5 score, NO, adropin and total testosterone (r = 0.380, p = 0.001; r = 0.507, p =  < 0.001; r = 0.246, p = 0.038, respectively). Meanwhile, there were significant negative correlations between ArIIEF-5 score, creatinine, duration of the disease and scores of GAD-7 and PHQ-9 (r = -0.656, p =  < 0.001; r = -0.368, p = 0.002; r = -0.663, p =  < 0.001; r = -0.248, p = 0.037, respectively). Finally, a linear regression analysis revealed that GAD-7, creatinine, and adropin were the only strong independent predictors of ArIIEF-5, as the 95% confidence interval in the form of upper and lower bounds was -0.349, -0.843, p < 0.001, -6.507, -18.402, p < 0.001, 0.476, 0.117, and p 0.002, respectively. Impaired NO and adropin levels play a potential role in the development of ED in patients with NAFLD.

Serum nesfatin-1 level in men with diabetes and erectile dysfunction correlates with generalized anxiety disorder-7: A prospective comparative study

BACKGROUND

Current studies have suggested a close link between nesfatin-1, an appetite-related neuropeptide and gonadal hormones.

OBJECTIVES

We investigated the association between nesfatin-1 serum level and erectile dysfunction severity in men with diabetes as well as the generalized anxiety disorder-7 questionnaire, the patient health questionnaire-9, serum testosterone, kidney and liver functions, glycated haemoglobin and lipid profile.

MATERIALS AND METHODS

Seventy-five participants between 30 and 60 years were enrolled, 25 erectile dysfunction patients with type 2 diabetes (group I), 21 with diabetes and preserved erectile function (group II) and 29 healthy controls (group III). Erectile dysfunction status and severity were determined by the Arabic version of the international index of erectile function-5 for all the participants. Psychological wellbeing was checked by the generalized anxiety disorder-7 questionnaire and the patient health questionnaire-9. Finally, participants were evaluated for serum nesfatin-1, serum testosterone, kidney and liver functions, glycated haemoglobin and lipid profile.

RESULTS

Serum nesfatin-1 levels were significantly lower in groups I and II compared to the controls. The international index of erectile function-5 scores had shown significant correlations with serum nesfatin-1, serum testosterone, generalized anxiety disorder-7, patient health questionnaire-9, diastolic blood pressure, glycated haemoglobin, triglycerides, creatinine and albumin/creatinine ratio. Receiver operating characteristic analysis revealed that serum nesfatin-1 ≥ 0.62 ng/ml, serum testosterone ≥2.9 ng/ml, generalized anxiety disorder-7 score ≥7.5, patient health questionnaire-9 score ≥5, glycated hemoglobin ≥6.4%, triglycerides ≥ 144 mg/dl, creatinine ≥ 0.85 mg/dl and albumin/creatinine ratio ≥ 26.5 are useful predictors of erectile dysfunction in men with type 2 diabetes, and the area under the curve for those variables was respectively 0.83, 0.76, 1, 0.75, 0.88, 0.72, 0.67 and 0.77. Finally, a linear regression analysis revealed that generalized anxiety disorder-7 was the only strong independent predictor of the international index of erectile function-5 (p < 0.001).

DISCUSSION AND CONCLUSION

Nesfatin-1 can be used as a biomarker for the severity of anxiety in erectile dysfunction patients with diabetes. Use of this molecule in treatment of diabetes and erectile dysfunction should be strengthened by larger studies. Psychiatric care must be offered to patients with diabetes and erectile dysfunction and low serum nesfatin-1 as they experience intense anxiety and depression.

Does chronic kidney disease affect the complications and prognosis of patients after primary colorectal cancer surgery?

BACKGROUND

The effect of chronic kidney disease (CKD) on the outcomes of colorectal cancer (CRC) patients after primary CRC surgery is controversial.

AIM

To analyze whether CKD had specific effect on the outcomes after CRC surgery.

METHODS

We searched the PubMed, Embase, Cochrane Library databases and CNKI, from inception to March 14, 2022. Newcastle-Ottawa Scale was used for the quality assessment in this meta-analysis, and we used RevMan 5.3 was used for data analysis.

RESULTS

A total of nine studies including 47771 patients were eligible for this meta-analysis. No significant difference was found in terms of overall postoperative complications [odds ratio (OR) = 1.78, 95%CI: 0.64-4.94, P = 0.27]. We analyzed the specific complications and found that the CKD group had higher rates of pulmonary infection (OR = 2.70, 95%CI: 1.82-4.00, P < 0.01), cardiovascular complications (OR = 3.39, 95%CI: 2.34-4.91, P < 0.01) and short-term death (OR = 3.01, 95%CI: 2.20-4.11, P < 0.01). After pooling the hazard ratio (HR), the CKD group had worse overall survival (OS) (HR = 1.51, 95%CI: 1.04-2.20, P = 0.03). We performed subgroup analyses of the dialysis and non-dialysis groups, and no significant difference was found in the non-dialysis group (HR = 1.20, 95%CI: 0.98-1.47, P = 0.08). The dialysis group had worse OS (HR = 3.36, 95%CI: 1.92-5.50, P < 0.01) than the non-dialysis group. The CKD group had worse disease-free survival (DFS) (HR = 1.41, 95%CI: 1.12-1.78, P < 0.01), and in the subgroup analysis of the dialysis and non-dialysis groups, no significant difference was found in the non-dialysis group (HR = 1.27, 95%CI: 0.97-1.66, P = 0.08). The dialysis group had worse OS (HR = 1.95, 95%CI: 1.23-3.10, P < 0.01) than the non-dialysis group.

CONCLUSION

Preexisting CKD was associated with higher rates of pulmonary infection, higher rates of short-term death, and worse OS and poorer DFS following CRC surgery.