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

Exploring symptom clusters in Chinese patients with peritoneal dialysis: a network analysis

BACKGROUND

In recent years, the research on symptom management in peritoneal dialysis (PD) patients has shifted from a single symptom to symptom clusters and network analysis. This study collected and evaluated unpleasant symptoms in PD patients and explored groups of symptoms that may affect PD patients with a view to higher symptom management.

METHODS

The symptoms of PD patients were measured using the modified Dialysis Symptom Index. The symptom network and node characteristics were assessed by network analysis, and symptom clusters were explored by factor analysis.

RESULTS

In this study of 602 PD patients (mean age 47.8 ± 16.8 years, 47.34% male), most had less than 2 years of dialysis experience. Five symptom clusters were obtained from factor analysis, which were body symptom cluster, gastrointestinal symptom cluster, mood symptom cluster, sexual disorder symptom cluster, and skin-sleep symptom cluster. Itching and decreased interest in sex may be sentinel symptoms, and being tired or lack of energy and feeling anxious are core symptoms in PD patients.

CONCLUSIONS

This study emphasizes the importance of recognizing symptom clusters in PD patients for better symptom management. Five clusters were identified, with key symptoms including itching, decreased interest in sex, fatigue, and anxiety. Early intervention focused on these symptom clusters in PD patients holds promise for alleviating the burden of symptoms.

Use of Sertraline in Hemodialysis Patients

Depression and anxiety are the most common psychiatric disorders in end-stage renal disease (ESRD) patients treated with hemodialysis (HD) and may correlate with lower quality of life and increased mortality. Depression treatment in HD patients is still a challenge both for nephrologists and psychiatrists. The possible treatment of depressive disorders can be pharmacological and non-pharmacological. In our article, we focus on the use of sertraline, the medication which seems to be relatively safe and efficient in the abovementioned population, taking under consideration several limitations regarding the use of other selective serotonin reuptake inhibitors (SSRIs). In our paper, we discuss different aspects of sertraline use, taking into consideration possible benefits and side effects of drug administration like impact on QTc (corrected QT interval) prolongation, intradialytic hypotension (IDH), chronic kidney disease-associated pruritus (CKD-aP), bleeding, sexual functions, inflammation, or fracture risk. Before administering the medication, one should consider benefits and possible side effects, which are particularly significant in the treatment of ESRD patients; this could help to optimize clinical outcomes. Sertraline seems to be safe in the HD population when provided in proper doses. However, we still need more studies in this field since the ones performed so far were usually based on small samples and lacked placebo control.

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.

Association between Psychopathological Dimensions and Sexual Functioning/Sexual Arousal in Young Adults

Psychological-psychiatric factors have a different effect on sexual functioning in men and women. This research aimed to examine the association between psychopathological dimensions and dimensions of sexual functioning in Spanish young adults in two studies. Study 1 examined sexual functioning and psychopathological dimensions in 700 women and 516 men. Study 2 conducted an experimental laboratory task to evaluate subjective sexual arousal and genital sensations when watching visual sexual stimuli in a subsample of participants from Study 1 (143 women and 123 men). As a result, the first study showed that depression and anxiety-related symptoms had a negative effect, both in men and women, and having a partner had a positive influence on the dimensions of sexual functioning. The second study showed that anxiety symptoms were positively associated with subjective sexual arousal in both men and women, and anxiety was associated with the assessment of genital sensations in men. The differences between the results of anxiety may be explained because sexual arousal was evaluated in general terms in Study 1, whereas it was evaluated as a state in Study 2. These findings confirm that the presence of psychopathological symptoms contributes to sexual functioning, as well as the necessity of strengthening mental illness prevention programs that include sexual health components.

Dialysis modality and sexual dysfunction in male patients

Sexual dysfunction is an under-recognised problem in due to very limited number of studies in the literature. This study aims to evaluate the sexual dysfunction related effects of dialysis modality among male patients with chronic renal failure. All patients were asked to complete 2 questionnaires: Hospital Anxiety Depression Scale [HADS] and International Index of Erectile Function [IIEF-5]. A total of 51 patients who completed the questionnaires were included in the study. 31 of them were under haemodialysis (HD) treatment, and 20 were under peritoneal dialysis (PD) treatment. After adjustment for age and HADS score, there was no statistically significant difference between HD and PD groups in terms of the mean IIEF scores (55 vs. 40, p = .058), and the frequency of sexual dysfunction (12.9% vs. 30%, p = .163). Age (r = -0.553), blood pressure (r = -0.299/ -0.374), use of iron (r = -0.333), lipid levels (r = -0.281/ -0.276) and HADS-D score (r = -0.276) inversely associated with IIEF score (p < .05). To conclude, sexual dysfunction is more common in patients who receive PD therapy than those who receive HD therapy. Older age, higher blood pressure, iron treatment, higher lipid levels and the presence of depression were associated with higher prevalance of sexual dysfunction.

Relationship between spiritual health and hope by dietary adherence in haemodialysis patients in 2018

Aim

The present study aimed to determine the relationship between spiritual well-being and hope through adherence to diet in haemodialysis patients referred to the dialysis centre.

Design

This research was a cross-sectional study of a descriptive-analytical type conducted on 120 patients undergoing haemodialysis in a haemodialysis centre of a hospital affiliated to Dezful University of Medical Sciences using the census method.

Method

The data were collected using a questionnaire and through the laboratory information included in the patient's records. The data collection tools were a demographic information questionnaire, the Ellison and Paloutzian spiritual well-being scale (SWBS), the Hope-Herth questionnaire and the objective laboratory criteria (phosphorus, potassium). This included the weight difference between the two dialysis sessions from the record to examine the adherence to the diet.

Results

The results indicate there to be a significant relationship between hope and spiritual well-being with the objective criteria of the adherence to the diet in dialysis patients (p = .001).

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.

Pharmacological and Non-pharmacological Treatment Options for Depression and Depressive Symptoms in Hemodialysis Patients

Depression is a mental disorder with a high prevalence among patients with end stage renal disease (ESRD). It is reported that depression afflicts approximately 20-30% of this patient population, being associated, amongst other, with high mortality rate, low adherence to medication and low perceived quality of life. There is a variety of medications known to be effective for the treatment of depression but due to poor adherence to treatment as well as due to the high need for medications addressing other ESRD comorbidities, depression often remains untreated. According to the literature, depression is under-diagnosed and undertreated in the majority of the patients with chronic kidney disease. In the current review the main pharmacological and non-pharmacological approaches and research outcomes for the management of depressive symptoms in hemodialysis patients are discussed.

Medication adherence in Greek hemodialysis patients: the contribution of depression and health cognitions

BACKGROUND

Several studies have shown that non-adherence is a common and increasing problem among individuals with chronic illnesses, including hemodialysis patients.

PURPOSE

The present study aimed to investigate the influence of depression and health cognitions on medication adherence among patients undergoing hemodialysis.

METHOD

A sample of 168 participants was recruited from six general hospitals in the broader area of Athens, consisting of patients undergoing in-center hemodialysis. Measurements were conducted with the following instruments: the Medication Adherence Rating Scale, the Center for Epidemiologic Studies Depression Scale (CES-D), and the Multidimensional Health Locus of Control (MHLC) scale.

RESULTS

The results indicated that medication adherence was associated positively with the dimensions of internal and doctor-attributed health locus of control, measured by the MHLC. It was also related negatively to depression, measured by the CES-D.

CONCLUSIONS

The present study demonstrates the importance of depression in understanding the medication adherence of hemodialysis patients, as well as the contribution of heath cognitions.

Chronic Kidney Disease, Spirituality and Religiosity: A Systematic Overview with the List of Eligible Studies

Chronic Kidney Disease (CKD) has a tremendous psychological burden, which sometimes is overlooked or underestimated in the daily clinical routine practice, since in the health care process physicians prefer to focus on the objective aspects of the pathology. In this contribution, we make a systematic overview of the relationship between spirituality/religiosity and CKD, an emerging theme which only recently has raised interest from the scientific community despite its importance. We investigate different variables, axis and categories (from the quality of life to customer’s satisfaction, treatment adherence and therapeutic alliance, clinical parameters, as well as overall survival, and coping strategies adopted by the patient). Moreover, we underpin the principal clinically relevant implications (like the possibility of psycho-therapeutic interventions based on the spiritual and religious attitudes of the patient) and we discuss the main gaps, methodological barriers and difficulties in the field, fostering and advocating further research and clinical studies. This last aspect, together with the quality assessment of the studies, will be further explored in the second part of the study.

Noncompliance with medical regimen in haemodialysis treatment: a case study

Patients undergoing haemodialysis treatment have a high burden of disease (particularly cardiovascular comorbidities) affecting their quality of life and dramatically shortening life expectancy. Effective chronic kidney disease (CKD) control requires regular preventive medication and a response to that medication. Poor receptiveness to CKD medication can be related to individual variability in the dose needed to achieve a response, as well as to low-adherent behaviour in relation to the CKD medication regimen. Some patients, though not many, according to studies' findings, abuse the medical regimen as a result of suicidal tendencies. The present case gave us the opportunity to consider the causes and clinical findings and review the specific psychological interventions for patients with CKD.