CLINICAL PROFILE, HORMONAL DISTURBANCES AND THE PSYCHOSOCIAL IMPACT OF SEXUAL DYSFUNCTION IN MALE CHRONIC KIDNEY DISEASE PATIENTS ON MAINTENANCE HEMODIALYSIS

Introduction:

Sexual dysfunction is common in people with Chronic Kidney Disease (CKD) and has been identified by people living with CKD as an important research gap. The prevalence in various studies is very high at about 62-77%. Historically, this cause of considerable morbidity has been under-reported and under-recognized. Taking sexual dysfunction into consideration while managing CKD patients will improve their quality of life. The ideal approach to diagnosis and management remains unclear due to a paucity of large clinical trials.

Methods:

This was a prospective cross-sectional study. Of the 182 patients undergoing maintenance hemodialysis in our center 64 male CKD patients of age 18 to 60 years were included in the study. Sexual dysfunction was assessed and graded using international index of erectile function (IIEF-5) questionnaire. Dialysis malnutrition score (DMS) was used for assessing nutritional status. Relevant clinical, socioeconomical and laboratory parameters were recorded which included complete blood count, electrolytes, liver function and renal function tests. Hormonal profile was assessed which included follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin and testosterone. Depression among the patients was assessed with HADS questionnaire. Patients with AKI, severe LV dysfunction and who are hospitalized with acute complications were excluded from the study. All data were processed by SPSS software.

Results:

Of the 64 patients included in the study, 50% belonged to the age group 41 to 50 years. 23% of them were smokers. 19% of the patients were diabetics. 9% and 11% of the patients had underlying coronary artery disease and chronic obstructive pulmonary disease respectively. 39% of the patients stopped having sexual intercourse. The frequency of sexual intercourse was about once a week in 12.5%, once in 15 days in 26.5% and once a month in 22% of the patients. 59% of the patients had moderate to severe malnutrition. Mean hemoglobin was 8.1 ± 1.5 gm/dl. Mean serum albumin was about 3.5±0.4 gm/dl. Based on IIEF-5 questionnaire, the prevalence of erectile dysfunction was about 88% of which 46% had mild to moderate and 28% had moderate grades of erectile dysfunction. Only about 9 % of the patients sought consultation regarding sexual dysfunction. Prevalence of Depression was about 33% as assessed using HADS-D questionnaire. About 76% of the patients are unemployed after initiating dialysis. Presence of malnutrition(p=0.017), reduced serum albumin(p=0.037), reduced serum testosterone levels(p=0.043) and elevated FSH levels(p=0.05) correlated with sexual dysfunction. Serum LH and prolactin levels were elevated in 89% and 81% of the study population.

Conclusions:

The prevalence of sexual dysfunction in CKD patients on dialysis is high and it still remains a taboo subject among the patients with only few patients seeking consultation regarding this issue. Presence of malnutrition, reduced serum albumin, elevated FSH and reduced testosterone levels correlated with sexual dysfunction. Though the prevalence is high, larger clinical trials exploring the treatment options are lacking which if addressed will improve the quality of life in patients with sexual dysfunction.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.