Male sexual function in patients receiving different types of renal replacement therapy in comparison with healthy men

There are limited studies correlating possible sexual functional alterations related to the mode of renal replacement therapy among end stage renal disease (ESRD). In this study, we performed a cross-sectional observational study to assess sexual function scores and biochemical variables that may have impact on male erectile dysfunction (ED) in ESRD patients. A total of 100 ESRD patients and 50 healthy men were recruited to the present cross-sectional study. The study was consisted of 53 renal transplantation (group I, mean age 39.01 ± 7.68 years, mean following duration 97.72±10.35 months) and 47 hemodialysis (group II, mean age 38.72±9.12 years, mean following duration 89.13 ±8.65 months). Meanwhile; control group consisted of 50 healthy men (group III, mean age 39.77± 8.51 years). Serum samples were obtained in each patient for serum blood urea nitrogen (BUN), creatinine, calcium, phosphore, total cholesterol, triglyceride, albumin, C reactive protein (CRP), intact parathyroid hormon (iPTH) and hemoglobin levels. All groups were evaluated with following scales; International Index of Erectile Function (IIEF)-5 and Short Form (SF)-36 questionnaires, Beck Depression Inventory (BDI). The patients whose IIEF score is ≤21 were accepted as erectile dysfunction. The mean age of the above-mentioned groups were similar (p> 0.05). Overall, total IIEF-5 scores of men in groups I, II and III were (19.5 4.5, 16.4 5.9 and 22.5 3.4 respectively). The mean total IIEF-5 score of control group was higher than group I and II (p< 0.001). Post transplant group's mean total IIEF-5 score was also higher than hemodialysis group (p< 0.05). Group I and II significantly differed from control group in terms of presence of ED (IIEF score ≤21) [(n=28, 52.8%), (n=29, %61.7), (n=12, %24) respectively (p < 0.001)] whereas there was no significant difference between group I and II. Physiological health domain of SF-36 was significantly better in healthy controls (p<0.001). Patient groups were similar in terms of BDI score did not reach to a statistical significance in patient groups (p>0.05). Erectile dysfunction score was negatively correlated with BDI (r= -0.368, p<0.001); whereas positively correlated with SF-36 (r=0.495,p<0.001) in all patient groups. In our cross-sectional study the men with ESRD had, significantly lower sexual function than the healthy control men. In summary, we noted lower sexual function and lower quality of life scores in patients with ESRD compared with healthy controls. Notably, the mode of renal replacement therapy had no impact on male sexual function and the cause of ED in this group of patients is probably organic in nature and related to uremia as well as other comorbid conditions rather than to psychogenic issues. For initial therapy, further studies are needed to understand underlying mechanism of sexual dysfunction in patients with ESRD. Thus, future research should include hypothalamic-pituitary-gonadal axis endocrine-hormonal distrubances with comparing sexual functions between pre and postdialysis, and also comparing sexual functions between pre and postrenal transplantation.