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Assessing sexual dysfunction in people living on dialysis in a New Zealand renal service
Abstract
Aim: This study sought to assess for people living in one large dialysis service in New Zealand their level of sexual functioning and also its importance to them. Background: Although there have been a number of international studies showing significant sexual dysfunction (SD) among people living on dialysis, there have been no published studies in Australia or New Zealand Method: A modified version of the Arizona Sexual Experience (ASEX) questionnaire was used to survey, by post, the dialysis population of the Auckland District Health Board (ADHB) Renal Service. Two new questions, added to the ASEX questionnaire, were asked about their degree of concern over their level of sexual functioning and its impact on their intimate relationships. Responses were analysed as a set of descriptive statistics. Results: This study showed significant levels of SD, 78%, for people living on dialysis in the Renal Service, similar to findings in similar studies elsewhere in the world. Despite these levels of SD, their level of sexual functioning was only of significant concern to 60% of participants and only had a negative impact on their intimate relationship for 42% of participants. Conclusion: The new questions could potentially usefully be used for initial screening to identify whether the person living on dialysis considers they have a problem, in order to determine if a full diagnostic screen for level of sexual functioning was of clinical relevance.
... The disease and hemodialysis weaken an individual's body image, self-esteem and self-care, affect the patient's sexual life and cause sexual dysfunction [3,4]. Sexual dysfunction is a very common complication in patients with chronic renal failure [5]. Sexual dysfunction is characterized with organic or physiological problems which lead to lack of sexual drive and a decrease in the frequency of sexual activity. ...
... Sexual dysfunction is characterized with organic or physiological problems which lead to lack of sexual drive and a decrease in the frequency of sexual activity. In several studies conducted with people with kidney failure receiving hemodialysis treatment, the prevalence of sexual dysfunction among them was determined to range between 41 and 93 % from one study to another [5][6][7]. A high level of sexual dysfunction experienced by a person affects his/her perception of health as well, because sexual health is considered as an important indicator of both physical and mental health [8]. ...
... This high level of sexual dysfunction can be interpreted as that the patients' sexual needs were neglected, which should be dealt with by health professionals as an important health problem. In line with the findings of this study, it can be said that due to the symptoms caused by the disease, psychological issues and changes that occur in the body, sufferers' life styles undergo changes, which [5][6][7]19]. Symptoms such as pain, movement restriction, fatigue and sleep disturbances caused by the disease had a negative effect on sexuality. However, emotional changes such as anxiety, sense of loss, fear of addiction caused by the disease, and the side effects of drugs used to treat the disease are reported to trigger this negative effect [20]. ...
This descriptive and correlational study was conducted to determine both sexual functions of patients with chronic renal failure on hemodialysis and the relationship between sexual function and “life satisfaction and perception of health”. The study was conducted with 125 patients with chronic renal failure who were treated at dialysis centers. Data were collected with the socio-demographic information form, Arizona Sexual Experience Scale (ASEX), Satisfaction with Life Scale and Nottingham Health Profile questionnaire. Of the participants, 72 % were over the age of 50 and 64.8 % had a chronic illness for six or more years. All the participants were receiving hemodialysis treatment. Of the participants, 85.6 % suffered from sexual dysfunction. There was a moderately significant positive correlation between the participants’ ASEX scores and the scores they obtained from the general perception of health, pain, physical fatigue, sleep and emotional subscales. However, there was not a significant relationship between ASEX mean scores and Satisfaction with Life Scale mean scores. The results of this study revealed that sexual dysfunction was common among patients with chronic renal failure and having hemodialysis therapy, and adversely affected their perception of health.
... Edema can affect both body image and sexuality. In this patient group, edema in the sacral/labial region is an important problem in this context [18,19]. Sexuality is one of the basic phenomena affecting the individual in terms of both physical and mental health [20,21]. ...
... tled by one's spouse, being supported by one's spouse, fear of being abandoned by one's spouse). According to the literature, the above-mentioned independent variables affect individuals' body image [9,12,13,15] and sexual life [17][18][19][20][21]. For this reason, it was thought that it would be appropriate to examine all these variables. ...
This study aimed to determine the body image and sexual experiences of patients receiving peritoneal dialysis treatment. This is a descriptive and relationship-seeking study. The study was conducted with 70 individuals receiving peritoneal dialysis treatment. The population of the study consisted of patients who continued their peritoneal dialysis treatment, and who could be reached by the snowball sampling method. The sample was determined with 0.85 power, 0.677 effect size, and a 0.05 margin of error. The data were collected using the Sociodemographic Introduction Form, the Body Image Scale, and the Arizona Sexual Experiences Scale. The mean body image scale (BIS) score of the participants was 113.84 ± 26.71, the Arizona Sexual Experiences Scale (ASEX) score was 17.37 ± 5.11, the duration of peritoneal dialysis was 3.09 ± 1.88 years, and the frequency of daily dialysis changes was 3.43 ± 1.25. The participants’ body image is moderate. PD patients experience sexual dysfunction. The most important result of the study is that PD patients have sexual dysfunction, and there is a negative relationship between body image and sexual dysfunction (p < 0.05). PD has a physical impact on patients. This impact affects both their body image and sexual functions.
... In our study, ASEX scores of patient group were significantly higher than the control group. This finding is consistent with the results of other studies showing that SD is more frequent in patients with chronic renal disease (3,4,35,36,37,38). In a study conducted with patients undergoing dialysis treatment, 65% of participants expressed dissatisfaction with their sexual life, 40% expressed that sexual intercourse does not arouse any more interest, and 25% expressed symptoms of probable SD (39). ...
... In a multicenter study performed by Peng et al. (40) on female patients undergoing hemodialysis, 55.7% of patients refused to participate in the study on account of the fact of no sexual life, and it was determined that 138 patients completed the study, and SD is significantly higher in patients than in healthy control subjects. Similar results have also been repeated in studies conducted on male patients with ESRD (38). ...
Introduction:
Due to disabilities caused by the disease and the requirement of dialysis, end-stage renal disease (ESRD) is frequently comorbid with psychiatric disorders, adversely affects quality of life, and causes significant sexual dysfunction (SD). We aimed to investigate the psychiatric comorbidity, quality of life, depression and anxiety levels, and SD in ESRD patients undergoing hemodialysis.
Methods:
Forty-nine patients undergoing hemodialysis treatment in a dialysis center and 44 non-ESRD control subjects selected with snowball sampling were enrolled in the study. All subjects were assessed using Structured Clinical Interview for Axis-I Disorders (SCID-I). Sociodemographic data form, Hospital Anxiety and Depression Scale (HADS), Arizona Sexual Experience Scale (ASEX), and World Health Organization Quality of Life Short Form Turkish Version Scale (WHOQOL-BREF-TR) were applied to both groups.
Results:
There was no difference between the groups in terms of sex, age, education period, marital status, presence of additional physical illness, and past history of psychiatric disorders. Compared with the control group, HADS depression subscale and ASEX scores were significantly high (p<0.01) in the patient group, and WHOQOL-BREF-TR psychological and physical domain scores were low (p<0.05 and p<0.01, respectively). There was a significant negative relationship between HADS scores and WHOQOL-BREF-TR psychological, environmental, and national environmental scores in the patient group (p<0.05). When the differences between the groups were re-analyzed after controlling HADS depression scores with covariance analysis, the significant difference in ASEX and WHOQOL-BREF-TR physical domain scores between the groups remained, but the significant difference in WHOQOL-BREF-TR psychological domain scores disappeared.
Conclusion:
The quality of life of ESRD patients was lower, especially in the psychological and physical domains, and psychiatric comorbidities and SD rates were higher than in non-ESRD control subjects. Quality of life is affected by SD. Recognizing and treating depressive symptoms will help improve the quality of life, especially in the psychological domain.
... Sexuality, which is an indispensable part of a healthy lifestyle and a fundamental human right and requirement, can be significantly affected in patients with CRF [7]. Sexual dysfunction is a prevalent complication in patients with chronic renal failure. ...
Sexual dysfunction is one of the most common problems in patients with advanced renal failure. This review aimed to determine the sexual problems and counseling needs of female patients receiving hemodialysis and peritoneal dialysis treatment, to identify gaps in the literature, and to make suggestions for future research. Pubmed and Ulakbim databases were examined by using the keywords "hemodialysis," "peritoneal dialysis," and "sexual function," "sexual counseling." It has been reported that patients receiving hemodialysis and peritoneal dialysis treatment have different symptoms due to conditions affecting life, such as comorbidities, medications used, management of the dialysis treatment process, and compliance or non-compliance with diet. Sexual dysfunctions consist of problems such as decreased sexual desire, sexual aversion disorder, arousal and orgasm disorder, dyspareunia, and vaginismus in women. In the literature, it has been found that 85.6% or almost 91.5% of dialysis patients have sexual dysfunction. Sexual dysfunction has been found to increase even more in patients who experience difficulty in maintaining sleep and the accompanying symptoms of insomnia, shortness of breath, feeling uncomfortable and who still smoke. The fact that sexual dysfunction is at such a high level suggests that this issue deserves higher awareness and importance. Sexual dysfunction should be considered as an essential health problem by nurses who are health professionals. Nurses have an important role in the protection and development of sexual health and the evaluation of sexual dysfunction. Sexual counseling interventions in nursing aim to strengthen the sexual health of women receiving hemodialysis and peritoneal dialysis treatment, to determine the causes and characteristics of sexual problems, to make appropriate interventions to solve the identified problems, and to improve the quality of life.
... Generally, dialysis patients face several physical, psychological, and social issues that can have lasting effects on their life [2]. One of the unaddressed issues is sexual dysfunction, which is defined as lack of or decrease in sexual desire and difficulty with sexual arousal, pain during intercourse, or orgasmic dysfunction, whether organic or physiologic [9][10][11]. ...
Background:
Maintenance dialysis is the most common treatment for end-stage renal disease (ESRD) patients. One of the most ignored but important health issue among dialysis patients is sexual dysfunction, which interferes with quality of life (QoL). Studies showed that the side effects of the two conventional methods of dialysis (hemodialysis (HD) and peritoneal dialysis (PD)) are different on a patient's health. Therefore, we sought to compare the sexual dysfunction score, both male and female, between patients undergoing HD and PD.
Methods:
One hundred seventy adults (85 HD and 85 PD) subject with end-stage renal disease (ESRD) on dialysis for at least 2 months were included. For male subjects, the erectile function (EF) domain of the International Index of Erectile Function (IIEF) questionnaire was calculated. Moreover, the Female Sexual Function Index (FSFI) questionnaire was calculated for females. Data were analyzed via SPSS software. Two independent sample t-test with two-sided significance level of 5% was used for comparing the sexual dysfunction score between HD and PD patients.
Results:
Out of 170 patients with mean age of 49.34 ± 11.7 years, 52.9% were female. Better sexual function scores were obtained in the HD group's females for desire, orgasm, and satisfaction domains, as well as the total score (P = 0.03, 0.016, 0.02, and 0.039, respectively). The erectile function was significantly better in the PD group's males (P).
Conclusion:
We found better sexual life in the HD group's females and PD group's males. Considering dialysis as a life-long treatment of CKD patients, this part of a patient's life must be taken seriously by the healthcare providers to choose the most suitable method for patients based on their personalized conditions.
... In our study, as a result of interviews with SCID-I, any psychiatric disorder is diagnosed in 49% of patients, and major depressive disorder is diagnosed in 28.6%, and these rates are significantly higher than control group. Results of our study are consistent with the results of other studies pointing out to the frequent existence of comorbid psychiatric disorders in patients with chronic renal impairment (19,20,33,35 (38). ...
... This finding is closer to a study [30] conducted in Morocco which reported that 81% of hemodialysis patients suffered from a decrease in sexual activity after the onset of hemodialysis treatment. Additionally, Doss & Polaschek [31] found that 78% of patient in New Zeal reported some degree of sexual dysfunctions, despite being medically stable, and adequately dialyzed, having no significant anemia, and only mild inflammation. In other words, the incidence rate of sexual dysfunction reported to be 9% before the initiation of hemodialysis and increases to 60%-70% during hemodialysis treatment [32] . ...
... Bununla birlikte KBY hastaları sıvı-diyet kısıtlaması, ilaç, sık hastalık, anksiyete, depresyon ve cinsel işlev bozukluğu gibi bir takım sorunlar yaşayabilirler (5,6). Sağlıklı bir yaşam tarzının vazgeçilmez bir parçası ve temel bir insan hak ve gereksinimi olan cinsellik (7), KBY olan hastalarda önemli ölçüde etkilenebilir (8). Cinsel işlev bozukluğu, kronik böbrek yetmezliği olan hastalarda oldukça yaygın görülen bir komplikasyondur. ...
... Bununla birlikte KBY hastaları sıvı-diyet kısıtlaması, ilaç, sık hastalık, anksiyete, depresyon ve cinsel işlev bozukluğu gibi bir takım sorunlar yaşayabilirler (5,6). Sağlıklı bir yaşam tarzının vazgeçilmez bir parçası ve temel bir insan hak ve gereksinimi olan cinsellik (7), KBY olan hastalarda önemli ölçüde etkilenebilir (8). Cinsel işlev bozukluğu, kronik böbrek yetmezliği olan hastalarda oldukça yaygın görülen bir komplikasyondur. ...
... This finding is closer to a study [37] conducted in Morocco which reported that 81% of hemodialysis patients suffered from a decrease in sexual activity after the onset of hemodialysis treatment. Additionally, Doss and Polaschek [38] found that 78% of patient in New Zeal reported some degree of sexual dysfunctions, despite being medically stable, and adequately dialyzed, having no significant anemia, and only mild inflammation. In other words, the incidence rate of sexual dysfunction reported to be 9% before the initiation of hemodialysis and increases to 60%-70% during hemodialysis treatment [39]. ...
Background: Sexual health is an important aspect of Quality of life (QoL). It is a basic human right and a fundamental part of a full healthy life. Patients with Chronic kidney disease (CKD) worldwide suffer many physical dysfunctions including sexual activity. Psy
... This finding is closer to a study [30] conducted in Morocco which reported that 81% of hemodialysis patients suffered from a decrease in sexual activity after the onset of hemodialysis treatment. Additionally, Doss & Polaschek [31] found that 78% of patient in New Zeal reported some degree of sexual dysfunctions, despite being medically stable, and adequately dialyzed, having no significant anemia, and only mild inflammation. In other words, the incidence rate of sexual dysfunction reported to be 9% before the initiation of hemodialysis and increases to 60%-70% during hemodialysis treatment [32] . ...
Background: Sexual health is a basic human right and a fundamental part of a full healthy life. Patients with Chronic kidney disease (CKD) worldwide suffer many physical dysfunctions including sexual activity. Therefore, this study aims to assess the psychosexual dysfunctions experienced by hemodialysis male patients and their coping strategies. Methods: A descriptive research design is conducted in the hemodialysis units at Urology and Nephrology Center at Mansoura University. The data were collected from 100 hemodialysis male patients. The study Tools included the Arizona Sexual Experience Scale (ASEX), the Psychosexual Dysfunction Questionnaire and the Brief Cope Scale (BCS). Results: Obtained results revealed that most of the study of sample (94%) complained of many psychosexual dysfunctions while only 6% expressed no significant psychosexual dysfunctions. The studied patients used problem focused coping by 76% with total mean of (18.36) out of a possible score of (24). On the other hand, the studied patients used emotional focused coping by 57% with total mean of (50.24) out of a possible score of (88). Conclusion: The vast majority of the study sample does suffer multiple psychosexual dysfunctions. Both physical and psychological distress increase CKD male patients' psychosexual dysfunctions and indicate the necessity of introducing psychiatric liaison nursing programs to enhance their coping strategies in the hemodialysis care units.
... This finding is closer to a study [21] conducted in Morocco which reported that 81% of hemodialysis patients suffered from a decrease in sexual activity after the onset of hemodialysis treatment. Additionally, Doss & Polaschek [22] found that 78% of patient in New Zeal reported some degree of sexual dysfunctions, despite being medically stable, and adequately dialyzed, having no significant anemia, and only mild inflammation. In other words, the incidence rate of sexual dysfunction reported to be 9% before the initiation of hemodialysis and increases to 60%-70% during hemodialysis treatment [9,23] . ...
Background: Chronic kidney disease (CKD) is a worldwide public-health problem in which most of the physical functions of the body are affected including sexual function. Apart from physical impacts due to renal failure, there are a number of psychological impacts that may also contribute to changes in sexual functioning. Therefore, the aim of this study is to assess the prevalence of psychosexual dysfunctions experienced by hemodialysis male patients. Methods: A descriptive cross-sectional research design was conducted in the hemodialysis units at Mansoura Urology and Nephrology Center. The data were collected from 100 hemodialysis male patients who corresponded to the inclusion criteria. Arizona Sexual Experience Scale (ASEX) and Psychosexual Dysfunction Questionnaires were used to achieve the purpose of the study. Results: The results indicate that (94%) of the study sample complain of psychosexual dysfunctions. The most prevalent psychosexual dysfunctions are psychosexual discomfort, fatigue, low self-esteem during sex, difficulty in reaching orgasm, difficulty in maintenance erection and low sexual desire while suicidal ideation was the lowest prevalent psychosexual dysfunctions. Conclusion: The vast majority of the study sample has psychosexual dysfunctions. Application of psychiatric liaison nursing program in hemodialysis units is recommended.
Introdução: A doença renal crônica (DRC) causa prejuízos na capacidade funcional dos pacientes, comprometendo a qualidade de vida (QV). Objetivo: Avaliar a QV de pacientes com DRC em hemodiálise e compará-la entre gênero, estado civil e situação ocupacional. Métodos: Estudo observacional e transversal com portadores de DRC. Utilizou-se o Kidney Disease Quality of Life Short Form (KDQOL-SF). Resultados: Foram avaliados 60 pacientes, 31 homens, idade média de 56,3±12,3 anos. As mulheres apresentaram pior função física (p=0,02), capacidade física (p=0,04), emocional (p=0,02) e escore total do KDQOL-SF (p=0,03). Indivíduos viúvos apresentaram pior vitalidade/fadiga (p=0,01) e função cognitiva (p=0,01). Indivíduos empregados apresentaram menor efeito da DRC na vida diária (p=0,01) e no escore total do KDQOL-SF (p=0,01). A idade correlacionou-se fraca e negativamente com a função física (r= -0,258; p=0,046) e função sexual (r= -0,323; p=0,012). Conclusão: Mulheres, indivíduos viúvos e mais velhos com DRC apresentam piores escores no questionário de QV.
Introdução: A doença renal crônica (DRC) causa prejuízos na capacidade funcional dos pacientes, comprometendo a qualidade de vida (QV). Objetivo: Avaliar a QV de pacientes com DRC em hemodiálise e compará-la entre gênero, estado civil e situação ocupacional. Métodos: Estudo observacional e transversal com portadores de DRC. Utilizou-se o Kidney Disease Quality of Life Short Form (KDQOL-SF). Resultados: Foram avaliados 60 pacientes, 31 homens, idade média de 56,3±12,3 anos. As mulheres apresentaram pior função física (p=0,02), capacidade física (p=0,04), emocional (p=0,02) e escore total do KDQOL-SF (p=0,03). Indivíduos viúvos apresentaram pior vitalidade/fadiga (p=0,01) e função cognitiva (p=0,01). Indivíduos empregados apresentaram menor efeito da DRC na vida diária (p=0,01) e no escore total do KDQOL-SF (p=0,01). A idade correlacionou-se fraca e negativamente com a função física (r= -0,258; p=0,046) e função sexual (r= -0,323; p=0,012). Conclusão: Mulheres, indivíduos viúvos e mais velhos com DRC apresentam piores escores no questionário de QV.
The actual and desired frequency of intercourse was studied in 68 randomly selected chronic peritoneal dialysis (CPD) patients. The results were correlated with standard measures of depression (Beck Depression inventory), anxiety (Patient Related Anxiety Scale), physical symptoms (Kupfer-Detre System 2), adequacy of dialysis (KT/Vurea) and nutrition (serum albumin level). In addition, patients assessed their quality of life (PAQOL) using an 1 to 10 analog scale. The mean +/- SD age of all patients studied was 54 +/- 11 yr, the mean dialysis duration was 24 +/- 24 months; 46% of the patients were female, and 34% were diabetic. Sixty-three percent of the patients reported never having intercourse (Group 1), 19% reported having intercourse < or = two times per month (Group II), and 18% reported having intercourse > two times per month (Group III). Dialysis duration, serum albumin level, KT/Vurea, and age were not significantly different among the three groups. Nearly 50% of patients in Group I desired to have intercourse, and 54% of the patients in Group II desired to have intercourse more frequently, Group I patients had significantly higher depression and anxiety scores, more physical symptoms, a poorer overall PAQOL, and less satisfaction with their sexual activity than Group III patients. These results suggest that there is a high prevalence of sexual difficulties in CPD patients. Patients not having intercourse have a poorer quality of life and higher degree of depression and anxiety than patients having intercourse more than two times per month.
Erythropoietin (rHuEpo) therapy has been shown to improve sexual function in the male dialysis population, with several studies suggesting a direct effect upon endocrine function, as well as correction of anaemia. Nevertheless many male dialysis patients receiving rHuEpo continue to complain of sexual dysfunction.
At a dedicated renal impotence clinic, 65 male dialysis patients were screened for endocrine disturbances. Baseline serum sex hormones were compared between those receiving and not receiving rHuEpo, using either the two-sample t test or the Mann-Whitney U test, after assessing for normality. Results from four patients were excluded on account of either medications (antiemetic phenothiazines), hepatic dysfunction, or carcinomatosis.
Twenty-five patients (41.0%) were receiving rHuEpo, the recipients and non-recipients being well matched for haemoglobin (10.19 +/- 0.29 vs 10.55 +/- 0.25 g/dl, n.s.), age (51.1 +/- 1.9 vs 53.6 +/- 2.1 years, n.s.) and duration of sexual dysfunction (median, 3.0 vs 3.0 years, n.s.). The rHuEpo recipients had a higher median creatinine (1090 vs 972 micromol/l, P < 0.02), but similar nutritional status to the non-recipients (albumin 41.0 vs 39.0 g/l, n.s.). The total duration of rHuEpo therapy was 0.85 +/- 0.14 years. Prolactin levels were similar in both the rHuEpo recipients and non-recipients (440 vs 541 mu/l, n.s.), as were LH (11.0 vs 10.5 iu/l, n.s.) and FSH (8.0 vs 6.5 iu/l, n.s.). However, there were significant elevations of testosterone (19.8 +/- 1.3 vs 16.1 +/- 1.1 nmol/l, P < 0.05) and sex hormone binding globulin (SHBG) (40.5 vs 26.0 nmol/l, P < 0.01), with a trend toward elevated oestradiol (304 vs 248 pmol/l, P = 0.095) in the rHuEpo-treated group. Forty-eight subjects (78.7%) received peritoneal dialysis (PD), with the 19 rHuEpo recipients (39.6%) demonstrating increased serum testosterone (21.0 +/- 1.5 vs 16.6 +/- 1.3 nmol/l, P < 0.05), SHBG (40.5 vs 26.5 nmol/l, P < 0.01), LH (15.0 vs 10.0 iu/l, P < 0.01) and FSH (12.0 vs 5.3 iu/l, P < 0.05). These differences were not demonstrated in the 13 haemodialysis (HD) subjects.
Male dialysis patients complaining of sexual dysfunction after correction of anaemia with rHuEpo are characterized by higher levels of serum testosterone and SHBG, but not suppression of hyperprolactinaemia or hyperoestrogenism. Male PD subjects receiving rHuEpo also demonstrated increased LH and FSH.
The beneficial effects of treating the anaemia of dialysis-dependent patients with erythropoietin on the improvement of cardiac status, exercise capacity, cognitive function and quality of life are well established. Equally, if not more important is the reduction in morbidity and mortality that accompanies the treatment of anaemia with epoietin. These documented improvements in outcomes of care notwithstanding, mortality and morbidity due to cardiovascular disease (CVD) remain high in dialysis patients. Recent epidemiological evidence indicates that: (i) the prevalence of CVD is very high in patients at the start of dialysis; (ii) pre-existing CVD is the major risk factor for mortality and morbidity on dialysis; (iii) CVD begins early in the course of kidney disease, shows an inverse relationship to kidney function and increases in prevalence and severity with progression of kidney disease; and (iv) corrective measures, which take 3-5 years to show a favourable effect, must be instituted well before the initiation of dialysis. Hypertension and anaemia, which develop in the course of progressive reduction in kidney function, are the principal risk factors for the prevalence of left ventricular hypertrophy (LVH) in those with chronic kidney disease, and their treatment has been shown to arrest or reverse LVH in these individuals. Whereas the treatment of hypertension early in the course of kidney disease has been incorporated into clinical practice, there has been reluctance in the treatment of anaemia because of the possibility of worsening kidney function with epoietin, as shown in rats. There is now convincing evidence that epoietin has no potential adverse effect on kidney function in humans. While the most compelling reason for the early treatment of the anaemia of kidney disease is its beneficial effect on cardiovascular function, other documented potential benefits are improvements in exercise capacity, cognitive function and quality of life.
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.
Sexual function is one aspect of physical functioning. Sexual dysfunction, no matter the etiology, could cause distress. In female hemodialysis patients, sexual problems have often been neglected in clinical performance and research.
We conducted this study by use of self-reported questionnaires. A total of 578 female hemodialysis patients in northern Taiwan were included in this study. Demographic data, comorbid diseases, medications in use, biochemical, and hematologic parameters were analyzed. All patients were asked to complete by themselves three questionnaires: (1) the Index of Female Sexual Function (IFSF) to assess sexual function; (2) the Beck Depression Inventory (BDI) (Chinese version) to rate the severity of depressive symptoms; and (3) the 36-item Short Form Health Survey Questionnaire (SF-36, Taiwan Standard Version 1.0) to survey their quality of life.
A total of 138 female patients were enrolled into further analysis. The mean age was 48.7 +/- 11.2 years old. The mean IFSF score was 24.5 +/- 9.3. Age, BDI score, and serum triglyceride levels were the independent factors of dysfunction in each sexual functional dimension. Patients with higher IFSF scores had significantly higher scores in physical functioning and mental health (P= 0.007 and 0.018, respectively). Patients with higher intercourse satisfaction had significantly higher general health scores (P= 0.001).
Sexual dysfunction is frequent in the female hemodialysis population. It is strongly associated with increasing age, dyslipidemia, and depression. The subjects with sexual dysfunction had poorer quality of life. The diagnosis and treatment of sexual dysfunction should be included in the clinical assessment.
Sexual dysfunction can be a distressing side effect of renal failure, A variety of sexual problems are experienced by both men and women of all ages, including impotence, reduced libido, gynecomastia, anovulation, and infertility. The causes of these problems can be both physiological and psychological, and careful assessment is required to determine the nature of the problem in order to prescribe the most effective treatment. Sexual function is an integral part of the rehabilitation process, and in order for the patient to achieve the optimal level of well-being, medical and nursing staff should be aware of the patient's anxieties and should use empathic skills to offer practical help and counseling.
End-stage renal disease (ESRD) frequently occurs within the social context of relationships and has many predictable consequences in the experience of patients and their significant others. Relationship and sexual issues and concerns must be assessed early in the treatment process and be continually attended to as patients seek new levels of coping. Sex-role conflicts, changes in sexual functioning and sexual self-esteem, challenges to both physical and emotional intimacy, and the life-altering consequences of chronic illness are all very real for ESRD patients. If a holistic perspective on the health care needs of ESRD patients is to be a reality, it will contain a concern for, active attention to, and involvement in the relationship/sexual dimension of life.
About 50% of the population receiving peritoneal dialysis (PD) in the United States are women. Nephrologists generally address medical issues related to end-stage renal disease, ie, anemia, hypercholesterolemia, secondary hyperparathyroidism. In female PD patients, specific topics should also be addressed. They include menstruation, birth control methods, osteoporosis, child bearing, postmenopausal hormone replacement and its consequences, screening of gynecological malignancies, sexual problems, and hemoperitoneum. We briefly describe in a multidisciplinary view the management of these issues.
In evaluating outcomes in end-stage renal disease (ESRD), quality of life has become as important as morbidity and mortality. Various instruments are available to analyse patients' perceptions of the physical, psychological and social domains of health. Non-specific instruments, such as the Sickness Impact Profile, the Karnofsky Scale, and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), have been widely used in evaluating quality of life in various chronic diseases including ESRD. The Kidney Disease Quality of Life (KDQOL) questionnaire and other scales have also have been developed specifically for ESRD patients. Several studies have demonstrated a significant improvement in quality of life after initiation of epoetin treatment in both dialysis patients and those with early renal failure. Quality-of-life scores show a strong positive correlation with haemoglobin concentration. Other factors associated with better quality of life are higher socio-economic level and level of education. However, older age, comorbidity, diabetes, female sex, and unemployment have a negative influence on quality of life. In patients not yet on dialysis, quality of life deteriorates as the glomerular filtration rate decreases. The later the patient is referred to a nephrologist, the worse the quality of life. Recent studies show that quality of life is a prognostic factor for survival. Early and effective treatment of anaemia in ESRD patients is essential in maintaining quality of life both before and after initiation of dialysis.
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.
Sexual dysfunction is common in patients on hemodialysis. This narrative literature review utilized Roy's Adaptation Model to identify sexual dysfunction and its effect on adaptive modes in patients on hemodialysis. The majority of studies reviewed indicated a physiologic effect in men (78%). Fewer studies reported an effect on self-concept (66%), intimate relationship (21%), or family/social roles (less than 1%). Findings also revealed minimal patient expression of sexual dysfunction to health care providers.