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Chronic kidney disease (CKD) is associated with multiple complications, including alterations in the hypothalamic-pituitary-gonadal axis. There is a degree of hypogonadism and androgen deficiency in patients on dialysis that is unknown if it is due to the dialysis technique per se or if it is part of a natural decrease of the disease itself. As CKD progresses, symptoms such as erectile sexual dysfunction (ESD) manifest, which is defined as the inability to achieve or maintain an erection to perform sexual activity satisfactorily, decreased libido, cognitive alterations, among other complications. Prevalence of the (DSE) occurs between 26% to 66% in the different stages of chronic kidney disease. Despite the high prevalence, it is an underdiagnosed and little talked about problem among doctors and patients. Chronic renal polypharmacy, fatigue generated by chronic inflammation, anemia, alterations in mineral bone metabolism, underlying diseases, vascular access, both arteriovenous fistulas and temporary or tunneled catheters and peritoneal dialysis catheters, which in many cases produce, aesthetic discomfort, add factors to a great impact not only clinically but also psychologically on our patients that end up being reflected in their sexual life.
An observational, cross-sectional and analytical study was carried out in the prevalent male population on chronic dialysis in peritoneal dialysis (PD) and hemodialysis (HD) modalities of the Carlos G. Durand Acute Hospital in the city of Buenos Aires-AR, between the months of January to June 2023 with pre-dialysis blood sampling for serum measurement of total testosterone, bioavailable testosterone, Beta-2 microglobulin, and surveys were carried out in order to identify cardiovascular risk factors such as diabetes, obesity and what relationship they have with age, dialysis modality and testosterone levels. Hemodialysis sessions are triweekly in 77% of patients and biweekly in 23%, lasting 4 hours with hollow polyetherosulfone membranes adjusted to the body surface, 55% have AVF and 45% have a temporary catheter. As for PD patients, the solution used is Baxter with 2.5% glucose, where 37.5% make changes incrementally with individualized stays for each prescription ranging from 6 to 8h/day, and 62.5% full dose where stays are 6 hours.
Hypogonadism is defined as a testosterone deficiency of less than 3 ng/ml. The mean testosterone was 3.03 ng/ml (SD 1.14). The mean free testosterone was 1.31 (SD 0.41). In hemodialysis the mean Testosterone is 2.91 (SD 0.92) compared to peritoneal dialysis 3.53 (SD 1.97) p=0.17. There was no difference in Testosterone levels according to the dialysis modality. In diabetics the mean T is 3.11 (SD 1.01) compared to non-diabetics 3.00 (SD 1.25) p=0.78. No statistically significant differences were observed in the distribution of hypogonadism among diabetics p=0.55, between the different modalities p=0.47 or with time on dialysis. Enobese people, the mean Testosterone level is 2.93 (SD 0.74) compared to non-obese people, 3.07 (SD 1.31) p=0.74. There is a negative linear correlation between age and Testosterone, as age increases Testosterone levels decrease. (p=0.009). Testosterone deficiency was present in 21 of the patients, 49%.
Hypogonadism is a disease that is little talked about in the dialysis population, however, it has a great impact on their quality of life. The prevalence in our population was 48.84%, almost 50% present some degree of DSE, even so, we are within the expected range already described in the international literature. The results were not statistically significant in terms of dialytic modalities, HD vs PD, however, the population on PD had a higher mean 3.53 (SD 1.97) when compared to HD 2.91 (SD 0.92), to date there are no studies robust studies that demonstrate the kinetics of this molecule in the dialysate of both modalities, but it can be thought that in PD the higher values could imply greater free testosterone (TL) in serum, since in this dialytic modality there is greater protein loss and that could explain the relatively higher values than in HD. While in HD, our population is dialyzed with high-flux polyetherosulfone membrane, not reused, therefore, there is greater clearance of TL and a small percentage of protein-bound testosterone can be dialyzed by minimal convection in conventional dialysis with membranes. of high flow, that could be an explanation why they have a lower average. What was statistically significant was the correlation between age and testosterone, the older the age, the lower the testosterone values (p=0.009) and this result is the same for the general population, in this way it can be understood that hypogonadism is a factor that does not It can be corrected by dialysis treatment. Despite the biases presented by the study due to the small sample size, since the kinetics of this molecule in PD are unknown, it is extremely important to know the values in that population because the low levels of testosterone in dialysis patients may be involved, not only in decreased libido and DSE, but in phenomena of cognitive alterations, anemia, endothelial dysfunction, cardiovascular disease and increased mortality, with which we should consider offering treatment to improve quality of life, not only sexual, but also influencing the mortality.