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

Ex-vivo antioxidant, enzyme inhibitory properties and computational analysis unveil the molecular mechanism of cardiac and penile phosphodiesterase-5 inhibition by bacterial strain HOKA1 extract as an aphrodisiac's agent

The study uses in-vitro antioxidant, ex-vivo enzyme kinetics and in-silico approach using standard protocols to understand their inhibitory mechanism better. The study revealed that bacterial strain HOKA1 isolated from Oniru beach, grown in nutrient agar supplemented with sodium chloride (30%NaCl). Moreso, the bacterial strain HOKA1 extract showed better antioxidant capability and greatly reduced the penile and cardiac cGMP with the highest penile and cardiac concentration between 0.013 and 0.183 μM/Min as compared to the sildenafil citrate (0.00-0.203 μM/Min). Moreover, the kinetic parameters (Vmax and Km) effects revealed that bacterial strain HOKA1 extract inhibited PDE-5 activities better than sildenafil citrate. The GC-MS analysis revealed twenty-nine bioactive compounds in the extract, and these compounds could provide comprehensible supporting evidence for the antioxidant and inhibitory potential of the strain HOKA1 extract on PDE-5 activity. Molecular docking study revealed majority of the GC-MS-identified bioactive constituents from the HOKA1 extract showed high binding energy or lower bonding affinities (-6.8 to -3.3 kcal/mol) compared to reference drug sildenafil citrate (-9.6 kcal/mol), except campesterol (-10.0 kcal/mol); also, ergostane (-9.9 kcal/mol). The results of 100 ns simulation (RMSF, RMSD, Rg and H-bond) show extraordinary stability of PDE-5 with campesterol and ergostane, so also complimentary binding energy of MM-PBSA (campesterol -65.92±4.09 kcal/mol; ergostane -57.23±4.70 kcal/mol) indicating their probability of acting promising PDE-5 inhibitors. Therefore, the study revealed that bacterial strain HOKA1 extract showed a better aphrodisiac property, and its bioactive compounds (campesterol and ergostane) should be considered in upcoming rational development and design of more active selective PDE-5 inhibitors, making a treatment for erectile dysfunction.

Coping strategies and its relationship with sexual dysfunction in adults receiving haemodialysis and peritoneal dialysis: A cross-sectional study

AIM

To explore relationship coping strategies and sexual dysfunction, and the predictive factors of sexual dysfunction in adults receiving haemodialysis and peritoneal dialysis.

BACKGROUND

Sexual dysfunction is a common problem in adults receiving haemodialysis and peritoneal dialysis. This problem may be related to psychological and physiological conditions. However, the association between psychological conditions such as coping strategies and sexual dysfunction is not clearly understood.

DESIGN

This study is a cross-sectional study.

METHODS

The data were collected from November 2021 to July 2022 using the General Information Form, Arizona Sexual Experiences Scale: Female and Male Versions, and the Ways of Coping Inventory. Correlation and multiple regression analyses were conducted to investigate the relationship between coping strategies and sexual dysfunction.

REPORTING METHOD

STROBE checklist.

RESULTS

A total of 110 adults, 67 on haemodialysis and 43 on peritoneal dialysis, who met the eligibility criteria were included in this study. The optimistic, helpless and submissive approach sub-dimensions of coping strategies had positive correlation with sexual dysfunction in adults receiving haemodialysis. Among the sub-dimensions of the ways of coping inventory, helpless approach was positive predictor and seeking social support was negative predictor of sexual dysfunction in adults receiving haemodialysis. The coping strategies were not predictors of sexual dysfunction for adults receiving peritoneal dialysis.

CONCLUSIONS

This study showed that helpless coping strategy increases sexual dysfunction, and seeking social support decreases sexual dysfunction in haemodialysis.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

According to this study, social support is effective coping strategy for reducing sexual dysfunction. Education and support for effective coping strategies should be provided to dialysis patients by healthcare professionals at the start of dialysis treatment. Effective coping strategies should be integrated into routine care standards and nursing or hospital policies.

PATIENT OR PUBLIC CONTRIBUTION

Adults receiving haemodialysis and peritoneal dialysis were involved in this study.

Causal associations between prostate diseases, renal diseases, renal function, and erectile dysfunction risk: a 2-sample Mendelian randomization study

Background

Previous observational studies have found a potential link between prostate disease, particularly prostate cancer (PCa), and kidney disease, specifically chronic renal disease (CKD), in relation to erectile dysfunction (ED), yet the causal relationship between these factors remains uncertain.

Aim

The study sought to explore the potential causal association between prostate diseases, renal diseases, renal function, and risk of ED.

Methods

In this study, 5 analytical approaches were employed to explore the causal relationships between various prostate diseases (PCa and benign prostatic hyperplasia), renal diseases (CKD, immunoglobulin A nephropathy, membranous nephropathy, nephrotic syndrome, and kidney ureter calculi), as well as 8 renal function parameters, with regard to ED. All data pertaining to exposure and outcome factors were acquired from publicly accessible genome-wide association studies. The methods used encompassed inverse variance weighting, MR-Egger, weighted median, simple mode, and weighted mode residual sum and outlier techniques. The MR-Egger intercept test was utilized to assess pleiotropy, while Cochran's Q statistic was employed to measure heterogeneity.

Outcomes

We employed inverse variance weighting MR as the primary statistical method to assess the causal relationship between exposure factors and ED.

Results

Genetically predicted PCa demonstrated a causal association with an elevated risk of ED (odds ratio, 1.125; 95% confidence interval, 1.066-1.186; P < .0001). However, no compelling evidence was found to support associations between genetically determined benign prostatic hyperplasia, CKD, immunoglobulin A nephropathy, membranous nephropathy, nephrotic syndrome, kidney ureter calculi, and the renal function parameters investigated, and the risk of ED.

Clinical Implications

The risk of ED is considerably amplified in patients diagnosed with PCa, thereby highlighting the importance of addressing ED as a significant concern for clinicians treating individuals with PCa.

Strengths and Limitations

This study's strength lies in validating the PCa-ED association using genetic analysis, while its limitation is the heterogeneity in study results.

Conclusion

The results of this study suggest a potential link between PCa and a higher risk of ED.

Coronary artery calcification and aortic valve calcification in patients with kidney failure: a sex-disaggregated study

BACKGROUND

Chronic kidney disease (CKD) is linked to an increased cardiovascular disease (CVD) burden. Albeit underappreciated, sex differences are evident in CKD with females being more prone to CKD development, but males progressing more rapidly to kidney failure (KF). Cardiovascular remodelling is a hallmark of CKD with increased arterial and valvular calcification contributing to CKD. However, little is known regarding sex differences in calcific cardiovascular remodelling in KF patients. Thus, we hypothesise that sex differences are present in coronary artery calcification (CAC) and aortic valve calcification (AVC) in patients with KF.

METHODS

KF patients, males (n = 214) and females (n = 107), that had undergone computer tomography (CT) assessment for CAC and AVC were selected from three CKD cohorts. All patients underwent non-contrast multi-detector cardiac CT scanning, with CAC and AVC scoring based on the Agatston method. Baseline biochemical measurements were retrieved from cohort databases, including plasma analyses for inflammation markers (IL-6, TNF, hsCRP) and oxidative stress by skin autofluorescence measuring advanced glycation end-products (AGE), amongst other variables.

RESULTS

Sex-disaggregated analyses revealed that CAC score was associated with age in both males and females (both p < 0.001). Age-adjusted analyses revealed that in males CAC was associated with diabetes mellitus (DM) (p = 0.018) and CVD (p = 0.011). Additionally, for females CAC associated with IL-6 (p = 0.005) and TNF (p = 0.004). In both females and males CAC associated with AGE (p = 0.042 and p = 0.05, respectively). CAC was associated with mortality for females (p = 0.015) independent of age. AVC in females was not reviewed due to low AVC-positive samples (n = 14). In males, in multivariable regression AVC was associated with age (p < 0.001) and inflammation, as measured by IL-6 (p = 0.010).

CONCLUSIONS

In female KF patients inflammatory burden and oxidative stress were associated with CAC. Whereas in male KF patients oxidative stress and inflammation were associated with CAC and AVC, respectively. Our findings suggest a sex-specific biomarker signature for cardiovascular calcification that may affect the development of cardiovascular complications in males and females with KF.

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.

Symptom Burden before and after Dialysis Initiation in Older Patients

BACKGROUND AND OBJECTIVES

For older patients with kidney failure, lowering symptom burden may be more important than prolonging life. Dialysis initiation may affect individual kidney failure-related symptoms differently, but the change in symptoms before and after start of dialysis has not been studied. Therefore, we investigated the course of total and individual symptom number and burden before and after starting dialysis in older patients.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

The European Quality (EQUAL) study is an ongoing, prospective, multicenter study in patients ≥65 years with an incident eGFR ≤20 ml/min per 1.73 m2. Using the dialysis symptom index (DSI), 30 symptoms were assessed every 3-6 months between 2012 and 2021. Scores for symptom number range from zero to 30 and, for burden, from zero to 150, with higher scores indicating more severity. Using mixed effects models, we studied symptoms during the year preceding and the year after dialysis initiation.

RESULTS

We included 456 incident patients on dialysis who filled out at least one DSI during the year before or after dialysis. At dialysis initiation, mean (SD) participant age was 76 (6) years, 75% were men, mean (SD) eGFR was 8 (3) ml/min per 1.73 m2, 44% had diabetes, and 46% had cardiovascular disease. In the year before dialysis initiation, symptom number increased +3.6 (95% confidence interval [95% CI], +2.5 to +4.6) and symptom burden increased +13.3 (95% CI, +9.5 to +17.0). In the year after, symptom number changed -0.9 (95% CI, -3.4 to +1.5) and burden decreased -5.9 (95% CI, -14.9 to -3.0). At dialysis initiation, "fatigue," "decreased interest in sex," and "difficulty becoming sexually aroused" had the highest prevalence of 81%, 69%, and 68%, respectively, with a burden of 2.7, 2.4, and 2.3, respectively. "Fatigue" somewhat improved after dialysis initiation, whereas the prevalence and burden of sexual symptoms further increased.

CONCLUSIONS

Symptom burden worsened considerably before and stabilized after dialysis initiation. "Fatigue," "decreased interest in sex," and "difficulty becoming sexually aroused" were considered most burdensome, of which only "fatigue" somewhat improved after dialysis initiation.

The management of women with kidney disease

Chronic Kidney disease (CKD) is more prevalent among women than men in the United States. This review highlights the important yet unique considerations that should be made in the care of women with kidney disease including psychosocial issues, preventive care and family planning. We emphasize the critical work that needs to be performed to prevent kidney disease progression in this population and manage comorbid conditions. Significance statement: The health of women with kidney disease has been understudied. This review offers insights on key areas in the management of women with kidney disease.

Sexual function, depressive symptoms and quality of life of people undergoing hemodialysis therapy

Objective to analyze the correlation between sexual function, depressive symptomatology and quality of life of people on hemodialysis treatment. Method a cross-sectional study developed with 54 participants. Data collection occurred between the months of March and May 2020. The data were analyzed with the Mann-Whitney and Spearman Correlation tests, with a 95% confidence interval. Results the correlation between sexual function and depressive symptomatology was only clinically relevant for women (ρ= -0.724). Regarding quality of life, it was observed that the overall sexual function of men is negatively correlated with the pain dimension (ρ= -0.349) and with the social function (ρ= -0.347). For women, overall sexual function is positively correlated with physical function (ρ= 0.501), general health (ρ= 0.737), mental component (ρ= 0.497), sleep (ρ= 0.753), quality of social interaction (ρ= 0.621), and patient satisfaction (ρ= 0.457). Conclusion and implications for the practice increased sexual function was strongly correlated with reduced depressive symptoms and increased quality of life, implying the need to strengthen sexual approaches through protocols that provide referral flows to specialized trans-disciplinary teams.

Função sexual, sintomatologia depressiva e qualidade de vida de pessoas submetidas à terapia hemodialítica

RESUMO Objetivo analisar a correlação entre função sexual, sintomatologia depressiva e qualidade de vida de pessoas em tratamento hemodialítico. Método estudo transversal desenvolvido com 54 participantes. A coleta de dados ocorreu entre os meses de março a maio de 2020. Os dados foram analisados com os testes de Mann-Whitney e Correlação de Spearman, com intervalo de confiança de 95%. Resultados a correlação entre a função sexual e a sintomatologia depressiva somente foi clinicamente relevante para as mulheres (ρ= -0,724). Já em relação à qualidade de vida, observou-se que a função sexual geral dos homens está negativamente correlacionada com a dimensão dor (ρ= -0,349) e com a função social (ρ= -0,347). Já para as mulheres, a função sexual geral está positivamente correlacionada com a função física (ρ= 0,501), saúde geral (ρ= 0,737), componente mental (ρ= 0,497), sono (ρ= 0,753), qualidade da interação social (ρ= 0,621) e com a satisfação do paciente (ρ= 0,457). Conclusão e implicações para a prática o aumento da função sexual esteve fortemente correlacionado com a redução de sintomatologia depressiva e com o aumento da qualidade de vida, implicando a necessidade de fortalecer as abordagens sexuais por meio de protocolos que ofereçam fluxos de encaminhamento às equipes transdisciplinares especializadas.

Sexuality in Kidney Transplant Recipients: A Qualitative Study

End-stage kidney disease has a negative impact on patients’ quality of life. People who receive a kidney transplant experience an improvement in many areas of their daily life. Sexuality is a general component of health, which can be affected by end-stage kidney disease and kidney transplant. The aim of this study was to explore and understand the experiences and perspectives of kidney transplant recipients regarding their sexuality. A qualitative study based on Gadamer’s hermeneutic philosophy was carried out. Two focus groups and nine interviews were conducted with 18 kidney transplant recipients. Data were audio-recorded, transcribed, and analyzed with the help of qualitative analysis software. Two main themes emerged from the data: (1) “The impact of a kidney transplant on sexuality”, with the subthemes “sexuality is relegated to the background”, “physical decline acts as a sexual inhibitor”, and “changes in sexual activity following a kidney transplant”; (2) “Sexual education in kidney transplant recipients” with the subthemes “sexuality: a hidden concern amongst kidney transplant recipients” and “talking about sexuality with healthcare professionals”. Sexuality is a frequent concern among kidney transplant recipients. The physiological and emotional changes experienced after kidney transplant exert a great influence on their sexuality. Healthcare professionals rarely discuss sexuality concerns with kidney transplant recipients. Professional sexual education and assistance are necessary to improve sexual health satisfaction of kidney transplant recipients.