Erectile Dysfunction In Hemodialysis Patients Research Articles

Duration of chronic kidney disease: as predisposition factor for erectile dysfunction in routine hemodialysis patients

Background: Chronic kidney disease (CKD) has a high global prevalence with an estimated prevalence of 10.6%. While the global prevalence of erectile dysfunction (ED) is 18.4% in men aged> 20 years and 33% aged> 50 years. ED is found in 70% of CKD patients. The aim of the study is to determine the relationship between duration of chronic kidney disease with ED in patients undergoing routine hemodialysis.Method: A cross-sectional study conducted from 1 October 2018 to 18 June 2019 of 60 CKD patients undergoing hemodialysis. History and examination were carried out using the International Erectile Function Index (IIEF-5) questionnaire.Result: Out of 60 samples, 42 patients (70%) had ED. The average duration of chronic kidney disease resulting in mild, moderate-moderate and moderate ED was 10.94 ± 10.79, 24.20 ± 17.84 and 38.40 ± 16.78 months, respectively. Univariate analysis using Spearman rank correlation showed a direct relationship between the duration of CKD and DE (P = 0.00, R squared 0.814).Conclusion: Duration of chronic kidney disease has strong relationship with ED in hemodialysis patients

Determinants of Erectile Dysfunction in Hemodialysis Patients in CNHU-HKM, Cotonou

Objective: The purpose of this study is to identify determinants of erectile dysfunction in hemodialysis patients in CNHU-HKM, Cotonou. Method: It was a cross-sectional, descriptive and analytical study conducted over a period of six months, from 1st March to 30th August 2017. Prospective data collection was carried out, along with a comprehensive census of hemodialysis patients meeting inclusion criteria. Sexual function was assessed through full version of International Index of Erectile Function (IIEF). Results: 114 hemodialysis patients were included in the study, with mean age estimated at 51.05 years ± 11.66. Among the study population, 100 patients (87.7%) had hypertension as comorbidity, hypertensive Nephropathy (67.5%) and Diabetic Nephropathy (14%). The average duration on dialysis was 74.34 ± 55.74. Forty-three hemodialysis patients (37.7%) were with depression, 56 (49.1%) had lower testosterone, 38 (33.3%) high rate of LH and 63 (55.3%) high FSH. 98 (86%) of them experienced erectile dysfunction, 97 (85.1%) sexual desire disorder and 80 (70.2%) orgasm disorder. Determinants of erectile dysfunction in hemodialysis patients included age (p<0.001; OR=1.168), hypertension (p<0.001; OR=10,111), seniority in hemodialysis (p=0.008; OR=1.024), depression (p=0.022; OR=11,250) and testosteronemia (p=0.038; OR=0.740). Conclusion: Sexual dysfunction prevalence is high in patients receiving dialysis. There is need to include care and support in these patient’s treatment strategies.

Risk factors for erectile dysfunction in end-stage renal disease patients with short- or long-term hemodialysis therapy

The influence of prolongation of hemodialysis (HD) period for erectile dysfunction (ED) has not been well evaluated. We evaluated the effects of various factors including hemodialysis duration for ED in hemodialysis patients. One hundred seventy-eight HD patients including 50 patients who received HD more than 10 years were enrolled in this study. The questionnaire of the International Index of Erectile Function (IIEF)-5 in Japanese language was used for evaluation of ED status in this cohort. Various clinical factors of these patients were collected from review of medical records, and the relationship between these factors and ED status was also evaluated. The prevalence of diabetes (p < 0.001), obesity (p = 0.011), and hyperuricemia (p = 0.010) were significantly higher in patients with less than 10 years of HD (group 1) than those in patients with more than 10 years of HD periods (group 2). The mean score of IIEF-5 in group 2 was almost similar with that in group 1 (p = 0.452). Moderate to severe ED was also equivalent to that in group 1 (p = 0.988). More than 60 years old (p < 0.001) and absence of hyperuricemia (p = 0.002) appeared to be significant risk factors for moderate to severe ED in multivariate analysis. Long periods of chronic hemodialysis therapy did not affect ED status, and absence of hyperuricemia was the risk factor for moderate to severe ED in HD patients.

The efficacy of udenafil in end-stage renal disease patients undergoing hemodialysis

Introduction Erectile dysfunction (ED) is frequently observed in end-stage renal disease (ESRD) patients on hemodialysis (HD) compared to non-uremic patients. This situation causes severe psychogenic problems in patients and disrupts the quality of life. Different phosphodiesterase type 5 (PDE-5) inhibitors have been used, and efficacies revealed, for the treatment of ED in HD patients; however, there are no studies related to udenafil use or results for HD patients. This study retrospectively evaluated the efficacy and reliability of udenafil for HD patients. Materials and methods The laboratory findings, side effects after treatment, and International Index of Erectile Function (IIEF) scores before and after treatment were compared and evaluated for HD patients who applied to our urology clinic with ED complaints and were treated with udenafil. Results The results showed that in the HD patient group with ED, apart from ED, there were severe rates of other sexual dysfunction. In our patient group, there was a statistically significant improvement in all scores for erectile function (p = 0.033), orgasmic function (p < 0.001), sexual desire (p < 0.001), relationship satisfaction (p < 0.001), and general satisfaction (p < 0.001) after treatment. The reported side effects were headache in one patient and dyspepsia in one patient. Conclusion We concluded that udenafil is an effective and reliable treatment approach for HD patients; however, our results require support from prospective randomized crossover studies with sildenafil.

Erectile dysfunction in hemodialysis patients.

Erectile dysfunction (ED) is a common problem seen among patients on hemodialysis (HD), but it is still a taboo subject in our country. The attention given to this sexual problem remained low, and the prevalence of ED among these patients has not been well characterized. We carried out this study in order to determine the prevalence and severity of ED in HD patients. We conducted a descriptive cross-sectional study in our HD unit in March 2013. ED was evaluated using the International Index Erection Function. Thirty patients with a mean age of 49.1 years were eligible for this study. The main causes of chronic kidney disease were hypertension (62.5%) and diabetes (41.6%). The prevalence of ED was 80%, including 33.3% severe ED. Plasma levels of gonadotropins: luteinizing hormone (LH), follicule-stimulating hormone were in the standards except for one patient who had an elevated level of LH. Prolactin was elevated in four cases. ED was present in 8.4% of patients before the discovery of renal failure and in 91.6% of patients at the beginning of dialysis. For 19 patients (79.1%), the ED had increased during the dialysis sessions. A significant number of our HD patients presented with ED of varying degrees. Nephrologists should pay attention to the problem of ED in order to improve the quality of their life.

Associated factors and prevalence of erectile dysfunction in hemodialysis patients

The proposal of this study was to determine the prevalence and the associated factors of erectile dysfunction (ED) among hemodialysis (HD) patients. This was a cross-sectional study based on data collected from HD male patients. Clinical, demographic and laboratory data of all patients were collected in three HD clinics from December 2010 to June 2011. Patients answered questions of erectile function domain from International Index of Erectile Function. Data were evaluated by descriptive analysis and by univariate (ULRA) and multivariate logistic regression analysis (MLRA). Three hundred and five patients participated of the study. The prevalence of ED was 68.19%. ED was associated with diabetes (DM), benign prostatic hyperplasia, glomerulonephritis as cause of chronic renal failure (CRF), smoking habits, lower creatinine levels (ULRA), use of calcium channel blocker (MLRA), aging, lower education level, alcohol consumption, DM (as cause of CRF) and coronary insufficiency (ULRA and MLRA). ED was highly prevalent in the HD men. It was independently associated with aging, current use of alcohol, long alcohol use (even for those who do not drink more), lower education level, diabetes as cause of CRF, coronary insufficiency and use of channel blockers calcium.

Erectile dysfunction in male hemodialysis patients in China – one center experience

To evaluate the prevalence and the risk factors of erectile dysfunction in a Chinese cohort of hemodialysis (HD) patients. 63 male hemodialysis patients were assigned to HD group and 47 health volunteers were recruited as controls. The International Index of Erectile Function (IIEF-5) was used to assess erectile dysfunction (ED). All data were obtained by patient interviews and medical chart review. We measured the blood sex hormone of all the patients and volunteers. We divided those under 50 years HD patients into two groups according to erectile function (EF) score, Group A: EF score>=12, no ED or mild ED; Group B: EF score<12, moderate or severe ED. The incidence of ED was significantly higher and the erectile function score was significantly lower in the HD group than that in the control group. The level of follicle stimulating hormone, luteinizing hormone, prolactin, estradiol, progesterone were significantly higher and the level of testosterone was significantly lower in the HD group than that in the control group. Patients in Group A were younger and duration of dialysis were shorter than patients in Group B. The level of high density lipoprotein was higher and FSH was lower in Group A than that in Group B. A significant negative correlation was found between the EF score and the age, duration of dialysis, the level of FSH and PRL in the HD group. There was a positive correlation trend between EF score and T level, but this did not reach statistical significance (p>0.05). More patients had hypertension in the HD group. The age, duration of dialysis, hypertension, lipid disorder, the abnormality of hypothalamic-pituitary-gonadal axis were risk factors for ED in HD patients.

The Impact of Erectile Dysfunction on the Quality of Life of Men Undergoing Hemodialysis and Its Association with Depression

Erectile dysfunction (ED) is highly prevalent among men undergoing hemodialysis. This study was performed to identify the influence of ED on the patient's quality of life (QoL) and to evaluate the influence of depression on erectile function of these patients. For this multicenter cross-sectional study, 275 patients were interviewed through questionnaires: the five-item version of the International Index of Erectile Function was used for diagnosing and classifying ED; the Medical Outcomes Study Questionnaire 36-Item Short Form Health Survey (SF-36) for scoring QoL; and the Hospital Anxiety and Depression Scale (HADS) to evaluate depressive symptoms. Linear regression was used to examine the associations between some of the variables and ED. Predialytic biochemical and hematological parameters were determined during the longer interdialytic period. Patients had a mean age of 48.6 ± 12.8 years, and the ED prevalence was 72.3%. Advanced age, diabetes and depression score were independent risk factors for the development of ED as confirmed by linear regression (P < 0.001, P = 0.002, and P < 0.001, respectively). QoL was worse among patients with any degree of ED, and the scores were statistically significant for overall health rating (P = 0.016), physical composite score (P = 0.003), bodily pain (P = 0.042), physical functioning (P < 0.001), and vitality (P = 0.005). Furthermore, more severe forms of ED were associated with a lower QoL. After adjustment for some variables, such as age, time under dialysis, hemoglobin, albumin, parathyroid hormone, Kt/V, and depression, linear regression showed that domains related to poorer physical functioning (P = 0.047) and decreased vitality (P = 0.009) were significantly related to ED. Depression is an important trigger for the development of ED in hemodialysis patients, and this sexual condition is an independent risk factor for their poor QoL.

Intima‐media thickness of carotid arteries and erectile dysfunction in hemodialysis patients

The prevalence of erectile dysfunction (ED) in hemodialysis (HD) is extremely high. The objective of this study was to evaluate the association between the intima-media thickness of carotid arteries and ED in HD patients. The survey was organized as a cross-sectional study in men aged up to 65 years, in the HD. All respondents voluntarily completed the questionnaire of the International Index of Erectile Function-5, adjusted for the Serbian language, verified routine laboratory analysis, calculated body mass index, demographic structure, duration of dialysis, the presence of hepatotropic viruses and erythropoietin therapy, smoking and drinking alcohol, determined the quality of HD, verified significantly comorbidities and measured the intima-media thickness of carotid artery using the Doppler method. The prevalence of ED in our study was 82.2%. Erectile dysfunction significantly more prevalent in older (P = 0.001) and obese patients (P = 0.047). It is significantly represented in patients with cardiovascular disease (P = 0.006), in those who consume alcohol (P = 0.04) and patients with higher values of intima-media thickness of carotid arteries (P = 0.007). Spearman's coefficient of linear correlation (ρ=-0.34, P=0.006) and linear regression (b=-2.02, P<0.001) indicated a negative association between intima-media thickness and the International Index of Erectile Function score. The prevalence of ED in our patients was 82.2%, more common in older and obese patients, a significant determinant of alcohol consumption and cardiovascular disease. Increased thickness of the intima media of the carotid arteries was associated with a higher incidence of ED.

The use of oral sildenafil citrate in hemodialysis patients: A multi-center double-blind placebo-controlled study

Efficacy and safety of oral sildenafil citrate use in hemodialysis patients is not very well documented. We undertook a study to evaluate the efficacy and safety of oral sildenafil in treating erectile dysfunction in hemodialysis patients. A total of 50 male hemodialysis patients (mean age 49.2 years) with ED were recruited for this double- blind, placebo-controlled prospective study. Patients were randomized into two groups of 25 patients and received either a placebo or sildenafil. Patients in sildenafil group were started on a 50-mg dose, and the dose was increased to 100 mg if there was no response after 2 doses. Patients were asked to complete the International Index of Erectile Function (IIEF) and a global life-satisfaction questionnaire before and after each dose.Improvement was observed in 76% of the sildenafil patients compared with 12% of placebo patients using IIEF and global assessment questionnaire. Sildenafil was associated with improvement in the IIEF score in all domains except those related to sexual desire. Sildenafil use resulted in normal EF scores in 36% of sildenafil patients. No correlation was found between sildenafil failure and patient age, duration of ED and the duration and etiology of renal failure. Sildenafil was well tolerated. Side effects were rare but occurred equally in both groups.Conclusions: Sildenafil is a safe and satisfactory drug for improving erectile function in patients with ESRD without contraindications for this drug. Pretreatment scores on the IIEF may be useful in predicting the success of the treatment.

Does Renal Transplantation Improve Erectile Dysfunction in Hemodialysed Patients? What is the Role of Associated Factors?

Objective To assess the effect of successful renal transplantation on improvement of erectile function in hemodialysis (HD) patients and the relationship between the degree of patient response and other factors. Materials and methods From September 2002 to November 2005, erectile function of 64 patients on HD for at least 6 months was evaluated pretransplantation and 6 months posttransplantation by International Index of Erectile Function, version 5 (IIEF-5). Sixtyfour age-matched persons without renal impairment were enrolled as control group to compare erectile dysfunction (ED) prevalence with the HD group. We evaluated duration of HD, age, and site of arterial anastomosis. In an attempt to find predictors of improvement of ED, after kidney transplantation, we performed linear regression analysis with a backward method. Results The prevalence of ED in HD patients was 87.5%. Although there were some differences in the prevalence of ED between patients older versus younger than 50 years, the difference was not statistically significant. There was no relationship between the duration of dialysis and the severity of ED in HD group. Compared to the pretransplant IIEF-5 score (13.59), there was significant improvement (19.16). In an attempt to find predictors of ED improvement, we used a linear regression analysis with backward method. Pretransplant IIEF-5 score, age at the time of transplant, and anastomosis to the common iliac artery showed significant associations with improvement, but the duration of dialysis and anastomosis to internal iliac or external iliac artery did not. Conclusion The incidence of ED among hemodialyzed patients is high. Kidney transplantation is the key treatment for this complaint. ED has a major negative impact on the quality of life and family relations. Its treatment is associated with improvement of psychogenic factors. ED is a sensitive topic and many patients will not spontaneously discuss it with their physician, so better to include potency evaluation in posttransplantation list evaluations.

Erectile dysfunction in chronic renal failure patients undergoing hemodialysis in Egypt

In clinical practice, the attention given to sexual problems in patients with end-stage renal disease is low. In order to evaluate the erectile function in chronic renal failure patients undergoing hemodialysis (HD) as a renal replacement therapy in upper Egypt, we used the abridged version of the International Index of Erectile Function (IIEF-5). In all, 75 HD patients were subjected to clinical and laboratory investigations. The controls were 948 healthy males representing the general Egyptian population. The prevalence of erectile dysfunction (ED) among the HD patients was 82.5% compared to 30% among controls. The prevalence of ED in HD group was significantly higher than in controls. The prevalence of ED in HD patients <50 y was 80% and it was 88% in those > or =50 y, while the prevalence of ED among controls was 28 and 69.8%, respectively. The prevalence of severe degree of ED was significantly higher in both groups compared to controls, while moderate degree of ED showed a statistical significance compared to controls in age groups <50 y and mild degree of ED showed a statistical significance compared to controls in age groups > or =50 y. [corrected] Age (r=-0.3368, P<0.01), serum urea (r=-0.5974, P<0.001), and creatinine level (r=-0.5804, P<0.001) have a significant negative correlation with the presence of ED among HD patients, while serum hemoglobin (r=0.3396, P<0.001) and years of HD age (r=0.3147, P<0.01) have a significant positive correlation with the presence of ED among the HD patients. In view of the observed high prevalence of ED among the HD patients, we believe that a complete health evaluation of male HD patients should include a discussion about erectile function in the standard clinical care program of patients with renal disease.

Association of decreased quality of life and erectile dysfunction in hemodialysis patients

Quality of life in hemodialysis patients has been associated with treatment outcomes. We explored the impact of erectile dysfunction on quality of life in a cohort of hemodialysis subjects. A random sample of 302 Philadelphia area hemodialysis (HD) subjects was enrolled using a cross-sectional design. Subjects completed a self-administered questionnaire including items on sexual function, past medical history, and quality of life. Linear regression (accounting for sampling design by weighted estimation methods) was used to examine the associations between various measures of quality of life (the dependent variables) and erectile dysfunction (ED) and other variables (the predictor variables). We found the emotional domains of the SF-36, a multi-purpose, short-form health survey with 36 questions, to be more profoundly associated with ED than the physical domains. Using the physical and mental components of the SF-12, a new 12-item short form health survey as predictors of ED, only the mental composite score (MCS) was statistically significant after adjusting for age and diabetes (P = 0.008). Subjects with ED had significantly lower quality of life mean scores. In particular, ED was associated with poorer social interaction (mean score difference, -10.3, adjusted P < 0.001), decreased emotional well-being (-12.9, adjusted P = 0.005), more role limitations due to emotional problems (-22.9, adjusted P = 0.01), and poorer social function (-17.8, P = 0.001). Recent advances in therapies for ED warrant that the diagnosis and treatment of erectile dysfunction be included in the global health assessment by the nephrologists and primary care providers of patients with renal insufficiency, as it may improve the quality of life of patients.

Significant decrease of the International Index of Erectile Function in male renal failure patients treated with hemodialysis.

In order to evaluate the erectile function in male renal failure patients treated with hemodialysis (HD), we investigated the International Index of Erectile Function (IIEF) in patients and healthy controls. The subjects were 174 male patients treated with HD, of whom 43 had diabetes mellitus (DM) and the remaining 131 patients did not have DM. The controls were 1133 healthy males. We evaluated the prevalence of erectile dysfunction (ED) using the erectile function (EF) score, which is one of the five domains of the IIEF, in each age group (upto 39 y old, 40-49 y old, 50-59 y old, 60-69 y old). The severity of ED was classified into five categories using EF in each age group. The univariate logistic regression analysis and multiple variate analysis of IIEF in HD patients were performed. The prevalence of ED in HD patients was significantly higher than that in the controls in each age group. The severity of ED in HD patients was also significantly higher than that in the controls in each age group. In the logistic regression analysis and multiple variate analysis of IIEF in HD patients, DM and age were significant risk factors on sexual dysfunction. ED was more prevalent in male renal failure patients treated with HD than in the controls. In the patient group, ED was more prevalent in older DM patients.

Prevalence and determinants of erectile dysfunction in hemodialysis patients

The prevalence of erectile dysfunction (ED) among patients with end-stage renal disease (ESRD) is not known. A cross-sectional study was conducted to determine the prevalence of ED among a community-based hemodialysis (HD) population using a two-stage cluster random sampling design. The presence and severity of ED were assessed among 302 ESRD patients using the self-administered International Index of Erectile Function-5 (IIEF-5). Logistic regression was used to examine and test associations between ED and other medical conditions. The prevalence of any level of ED was 82% (95% CI, 76 to 87%) for all HD subjects. The prevalence of severe ED was 45% (CI, 36 to 55%). Subjects younger than 50 years had a prevalence of ED of 63% (CI, 53 to 71%), while in subjects 50 years or older, it was 90% (CI, 84 to 94%). A multivariable analysis demonstrated increasing age (50 to 59, OR = 2.04, 95% CI, 1.3 to 3.1; 60 to 69, OR = 5.5, 95% CI, 1.9 to 15.6) and diabetes (OR = 2.0, 95% CI, 1.2 to 3.3) to be independently associated with the presence of any level of ED. However, neither the subjects' age nor history of diabetes predicted the severity of ED among subjects with ED. The use of angiotensin-converting enzyme inhibitors (ACEIs) was inversely associated with ED (OR = 0.41, 95% CI, 0.17 to 0.98). Poor functional status (Karnofsky score or the Index of Physical Impairment) was not associated with ED. ED is extremely prevalent among HD patients. Increasing age, diabetes, and nonuse of ACEIs were associated with higher prevalence of ED. The high prevalence of ED was seen even among patients with good functional status.

Prevalence and determinants of erectile dysfunction in hemodialysis patients

Prevalence and determinants of erectile dysfunction in hemodialysis patients

Study of sexual function in male hemodialysis patients--analysis of the cause of erectile dysfunction

Erectile dysfunction is a well documented complication among male hemodialysis patients. The cause has been reported to be related to multiple factors, including neurological, endocrinological and vasculogenic elements. The purpose of this study was to identify the factors which most greatly determine erectile dysfunction in hemodialysis patients. Male hemodialysis patients without diabetes mellitus and severe anemia (Hb value < 8.0 g/dl) were entered into the study. We measured nocturnal penile tumescence (NPT) values in these patients and carried out neurological studies (measurement of the penile dorsal nerve conduction velocity and the bulbocavernosus reflex (BCR) latency). a vasculogenic study (measurement of the penile blood pressure index (PBPI) and endocrinological studies (measurement of serum free testosterone levels and serum prolactin levels before hemodialysis). NPT values (maximum penile circumference changes) in hemodialysis patients decreased compared with those in healthy males. In both hemodialysis patients and healthy males, NPT values decreased with age. NPT values in hemodialysis patients were significantly lower than those in healthy males in the fifties and sixties. 32.2% of hemodialysis patients had severe penile neurological disorder. 55.6% of them showed abnormal NPT. PBPI was low in only 10.0% of hemodialysis patients. However, there was a significant correlation between PBPI and the NPT value (r = 0.387). Serum free testosterone levels in hemodialysis patients were significantly lower than those in healthy males. There was a significant correlation between the serum free testosterone level and the NPT value (r = 0.328). However, there was no correlation between the serum prolactin level and the NPT value. To identify the factors which most greatly determine erectile dysfunction in hemodialysis patients, we carried out multivariate analysis. The criterion variables in this analysis were NPT values. The coefficient of determination was highest for a neurological disorder (30.7%), followed by an endocrinological disorder (a reduction in the serum free testosterone level) (11.6%) and a vasculogenic disorder (a reduction in PBPI) (4.2%).