Sexual dysfunction in female and male patients undergoing chronic ambulatory peritoneal dialysis

BACKGROUND

To prolong survival and to provide a better quality of life (QoL) are two aims at the forefront in the care of peritoneal dialysis (PD) patients. In this study we aimed to determine frequency of sexual dysfunction (SD) and influencing factors in PD patients.

METHODS

Of the 201 patients, 114 under 65 years and on chronic ambulatory PD for at least 3 months were enrolled. Forty-nine females and 65 males completed the study. Survey forms were applied using face-to-face interview method. Female Sexual Function Index (FSFI) was used to assess SD in women; International Index for Erectile Function (IIEF) was used to assess erectile dysfunction (ED) in men. All patients completed SF-36 and Beck Depression Inventory (BDI) forms.

RESULTS

While SD was evident in 89.8% of female patients (FSFI score:10.4 ± 9.7), ED was present in 87.7% of males (IIEF score:13.8 ± 7.9). Depression rates were 65.3% and 49.2% in female and male patients, respectively. BDI scores were 21.6 ± 10.4 and 17.1 ± 9.5; physical component scores, 52.6 ± 20.4 and 55.2 ± 20.2; mental component scores, 45.2 ± 19.8 and 49.9 ± 22, in female and male patients, respectively. FSFI was correlated with age (β = -0.53 p < 0.001) and BDI score (β = -0.23 p = 0.04), (R² = 0.64). ED showed correlation with age (β = -0.36 p < 0.001), BDI score (β = -0.57 p < 0.001), and hemoglobin level (β = 0.26 p = 0.003), (R² = 0.74).

CONCLUSION

SD, often overlooked and not discussed by both patients and physicians, is encountered relatively frequently among PD patients. Left not discussed and untreated SD may adversely affect QoL.

The impact of nocturnal hemodialysis on sexual function

Background

Sexual dysfunction is common in patients with end stage renal disease (ESRD) and treatment options are limited. Observational studies suggest that nocturnal hemodialysis may improve sexual function. We compared sexual activity and responses to sexual related questions in the Kidney Disease Quality of Life Short Form questionnaire among patients randomized to frequent nocturnal or thrice weekly conventional hemodialysis.

Methods

We performed a secondary analysis of data from an RCT which enrolled 51 patients comparing frequent nocturnal and conventional thrice weekly hemodialysis. Sexual activity and responses to sexual related questions were assessed at baseline and six months using relevant questions from the Kidney Disease Quality of Life Short Form questionnaire.

Results

Overall, there was no difference in sexual activity, or the extent to which people were bothered by the impact of kidney disease on their sex life between the two groups between randomization and 6 months. However, women and patients age < 60 who were randomized to frequent nocturnal hemodialysis were less bothered by the impact of kidney disease on their sex life at 6 months, compared with patients allocated to conventional hemodialysis (p = 0.005 and p = 0.024 respectively).

Conclusions

Our results suggest that frequent nocturnal hemodialysis is not associated with an improvement in sexual activity in all patients but might have an effect on the burden of kidney disease on sex life in women and patients less than 60 years of age. The validity of these subgroup findings require confirmation in future RCTs.

Evaluation of the relationship between endogenous gonadotropins and female sexual function and psychological status in predialysis and hemodialysis patients

OBJECTIVES

To evaluate sexual function and psychological state and the factors affecting female sexual dysfunction in predialysis and hemodialysis patients.

DESIGN AND METHODS

Forty-seven women with chronic renal failure including 22 predialysis patients, 25 hemodialysis patients, and 30 healthy controls were included in this study. Demographic and clinical variables of the patients were recorded. The sexual functions and psychological states of the patients, assessed by the Arizona Sexual Experiences Scale (ASEX) and Beck Depression Inventory (BDI), respectively, were compared between the groups.

RESULTS

Total ASEX scores, ability to reach orgasm, and BDI scores were significantly higher in predialysis and hemodialysis patients than controls, reflecting sexual dysfunction. The patients in the predialysis group were 6 and 3.8 times more likely to develop depressive symptoms compared to the controls and hemodialysis patients, respectively. The predialysis patients who showed depressive symptoms were 24 times more likely to develop sexual dysfunction compared to those without depression. Serum FSH and LH levels were also positively correlated with arousal and erection/lubrication scores in the predialysis patients with depressive symptoms.

CONCLUSION

Female predialysis rather than dialysis patients might be more likely to develop depression. Those patients with depressive symptoms may also be at greater risk of developing sexual dysfunction in which increased gonadotropin levels and age may also be contributing factors. Therefore, psychiatric and gynecologic consultations may be beneficial.

Sexual functioning after renal transplantation

Sexual dysfunction (SD) is common among end-stage renal disease (ESRD patients). Studies about SD in the posttransplantation period have reported various results. The aim of this study was to investigate SD prevalence and relationship to sociodemographic and clinical variables. Sexual functioning was measured using the Arizona Sexual Experiences Scale (ASEX), and depression by the Beck Depression Inventory (BDI) in 98 patients. We observed that 68 patients (69.4%) had SD; the prevalence rates were 56.9% for men and 93.4% for women. ASEX item scores among single patients were higher than those among married patients. Subjects with SD were more depressed (P < .001) and less educated (for female patients, P = .02). These findings showed that SD is common in Turkish patients, especially women. SD patients should be integrated into routine examination throughout the transplant, process, and when needed, their treatment management should include education regarding sexual life complaints.

Do sexual dysfunctions get better during dialysis? Results of a six-month prospective follow-up study from Turkey

Dialysis improves most symptoms of end-stage renal disease (ESRD), yet many patients continue to experience sexual dysfunction (SD) during the dialysis treatment. The aim of this preliminary study was to evaluate the frequency and the course of SD during a 6-month dialysis treatment. Additionally, relationships between the level of depression, cognitive impairment and biochemical parameters of SD were also assessed. The subjects were 43 ESRD (25 male and 18 female) on dialysis treatment for at least 12 months. SD was assessed using the Arizona Sexual Experiences Scale (ASEX); the level of depression and cognitive impairment were assessed using the Hamilton Depression Rating Scale (HDRS) and Mini Mental Status Exam (MMSE). Several biochemical parameters were also assessed. All assessments were carried out at baseline and repeated at 6-month follow-up. Of 43 patients, 20 (47%) and 18 (42%) complained of SD at baseline and at 6-month assessments, respectively. Of 25 males, nine (36%) and seven (28%) patients described SD at baseline and 6-month assessments, respectively; erectile dysfunction was the most frequent complaint. Of 18 females, 11 (61%) and 11 (61%) patients reported SD at baseline and 6-month assessments, respectively; difficulties with arousal and reaching orgasm were the most frequent complaints. Both total and item-by-item comparisons of baseline and 6 months ASEX scores did not reveal any significant changes during 6-month period, indicating that patient's sexual functions do not improve with dialysis treatment. For female patients, HDRS scores were significantly higher in patients with SD at baseline (t = 2.15, P = 0.05) and at 6-month follow-up (t = 2.44, P = 0.03) assessments; after excluding the effects of age and duration of dialysis for females using regression analysis, HDRS still significantly (t = 4.02, P = 0.003) associated with the SD. This preliminary prospective study suggests that SD is frequent in dialysis patients, does not remit with dialysis treatment, associated with depression in female patients, and much clinical attention is indicated.

The reliability and validity of Arizona sexual experiences scale in Turkish ESRD patients undergoing hemodialysis

Although sexuality was the fifth most important life stressor cited by dialysis patients, sexual dysfunctions (SD) receive a very limited attention in the follow-up of these patients. The main aim of the present study was to investigate the reliability and validity of the Arizona Sexual Experiences Scale (ASEX) for end-stage renal disease (ESRD) patients undergoing hemodialysis (HD) in Turkey. The instrument's reliability and validity were assessed in 43 ESRD outpatients undergoing dialysis. All patients were assessed at baseline and at 6 months. ASEX showed good internal consistency (Cronbach's alpha's 0.89 and 0.90) and test-retest reliability (r=0.88, P<0.001). Convergent validity of ASEX was measured by means of the scales' correlation with the psychiatrists' assessment for the presence of SD (r=0.53, P<0.001). The results of receiver operating characteristics analysis for criterion validity revealed that ASEX scores could discriminate well (0.85+/-0.06 (95% confidence interval, 0.73-0.90), P<0.001) between patients with 'no SD (n=26)' and 'with SD (n=17)'. A total ASEX score of < or =11 was found to be the best cutoff point (sensitivity=100%, specificity=52%) for screening in this group of patients. The findings of this study indicate that the ASEX is a valid and reliable instrument for use in clinical trials on sexual functioning of ESRD patients undergoing HD.

Depression in chronic haemodialysed patients

From April 2000 to April 2001, a total of 108 chronic stable haemodialysed patients (34 males aged 57.76 +/- 12.68 years under haemodialysis treatment for 31.41 +/- 24.71 months and 74 females aged 54.99 +/- 12.87 years under haemodialysis for 41.47 +/- 33.47 months) were studied for signs of clinical depression. Depression was measured by using 'The Taiwanese Depression Questionnaire (TDQ)'. After analysing various possible factors, we chose to study three dimensions: affective change, somatic complaint and cognitive disturbance. Thirty-six (33.4%) of the patients were found to have TDQ scores above 19; our cut-off value. Diabetic patients were also found to have higher depression scores and affective change scores than those without diabetes. The elderly suffered more from somatic complaints, and patients without jobs also tended to have higher depression scores. We compared the nutrition indexes and uraemic toxin removal indexes of those with higher depression scores (score > or =19) with those with normal scores (score <19), and we found no differences between the two groups. We found that an underlying disease and job status were the major differences found in the two groups. Therefore, our findings suggest that the depression found in our chronic haemodialysed patients was not a result of the physical conditions, but a result of psychosocial problems indicating a need for psychosocial support for these patients.

Impact of chronic renal failure and peritoneal dialysis fluids on advanced glycation end product and iNOS levels in penile tissue: an experimental study

OBJECTIVES

To investigate the impact of chronic renal failure (CRF) on advanced glycation end product and inducible nitric oxide synthase (iNOS) in penile tissue, we examined the advanced glycation end product 5-hydroxy methyl furfural (5-HMF) content and iNOS expression in rats in which uremia had been produced by greater than 85% nephrectomy. In addition, the contribution of peritoneal dialysis (PD) fluids to the elevation of penile tissue 5-HMF levels and iNOS staining scores has been investigated.

METHODS

Adult male Wistar rats, aged between 10 and 12 weeks and weighing 200 to 330 g, were divided into five groups that each included 6 animals. The first group served as a control group. In the second group, CRF was induced and a peritoneal catheter was implanted, but PD was not performed. In group 3, CRF was induced and PD was performed using dialysis fluids containing 1.36% glucose and icodextrin. In group 4, CRF was also induced and PD was performed using 3.86% glucose and icodextrin. Finally, in group 5, without CRF, an indwelling catheter was implanted, and the PD procedure was performed using dialysis fluids containing 3.86% glucose and icodextrin.

RESULTS

The elevation in 5-HMF levels and iNOS staining scores in penile tissue from groups 2, 3, 4, and 5 was significant compared with group 1 (P <0.05). The elevation in 5-HMF levels and iNOS staining scores was also significant between groups 2 and 3, 2 and 4, 3 and 4, 3 and 5, and 4 and 5 (P <0.05). Moreover, the correlation between the 5-HMF levels and iNOS staining scores was statistically significant (r = 0.525, P = 0.003).

CONCLUSIONS

In the present experimental study, we found that 5-HMF levels and iNOS staining scores were significantly elevated in rat penile tissue in which uremia had been produced compared with the groups without CRF. Additionally, PD fluids containing glucose had an effect on the elevation of penile tissue 5-HMF levels and iNOS staining scores.