Survival of Patients on Hemodialysis with Erectile Dysfunction

Abstract

Background and objectives: In patients on hemodialysis, erectile dysfunction is an independent mortality factor. This study aimed to determine the risk factors that affect the survival of hemodialysis patients with erectile dysfunction. Materials and Methods: During a seven-year period, erectile dysfunction was identified among the fatalities reported in patients receiving chronic hemodialysis, on the basis of the International Index of Erectile Function questionnaire. The study covered 70 patients of mean age 57 ± 6.7 years. During the examined period, 42 (60%) patients died at the mean age 57 ± 6.8 years. The study was completed by 28 (40%) patients, aged 57 ± 6.55 years. Laboratory, demographic, anthropometric, and clinical characteristics were recorded using standard methods. Results: Statistically significant differences between the two groups of respondents were found concerning dialysis duration (p < 0.001), number of leukocytes (p = 0.003), adequacy of hemodialysis (p = 0.004), intima media thickness of the carotid artery (p < 0.001), presence of cardiovascular disease (p = 0.03), residual diuresis (p = 0.04), and hemodiafiltration (p < 0.001). Hemodialysis adequacy (B = −9.634; p = 0.017), intima media thickness (B = 0.022; p = 0.003), residual diuresis (B = −0.060; p = 0.007), and lower rates of cardiovascular disease (B = 0.176; p = 0.034) were significant survival predictors among our patients with erectile dysfunction. Conclusions: Risk factors that are associated with improved survival of patients on hemodialysis with erectile dysfunction in our study are: preserved diuresis, high-quality hemodialysis, lower incidence of cardiovascular disease, and less thickening of the intima media of the carotid arteries.

The Importance of Reporting Clinical and Epidemiological Data in Urology: Local Experiences and Insights from the International Literature

“…In the study by Stolic et al, the survival of patients on hemodialysis with ED (an independent risk factor for mortality) was assessed: from the cohort of 70 patients, 60% (n = 42) died during the study period (mean age: 57 ± 6.8 years). Overall, their study highlighted that preserved diuresis, lower severity of cardiovascular illness, less-thick intima media in the carotid arteries, and high-quality hemodialysis were all associated with improved survival in patients with hemodialysis [30]. Bener et al compared the prevalence of ED among men with normal blood pressure and men with hypertension in Qatar, using the International Index of Erectile Function (IIEF) as a scale of sexual dysfunction: among n = 296 patients with hypertension, 66.2% had ED, while this ratio was much lower among normotensive patients (p < 0.001); additionally, age, highest level of education, presence of T2DM, and current occupation all had significant influence on the level of sexual dysfunction [31].…”

The prevalence and severity of mental health problems and sexual dysfunction in hemodialysis patients before and during the COVID‐19 pandemic

“…Similarly, in a past study with 659 women receiving chronic hemodialysis, the authors reported that of the six FSFI‐defined domains of sexual function, satisfaction was the least impaired [6]. Indeed, in a study among women from the general medical population, the authors also reported while nearly half of study participants had FSFI‐defined sexual dysfunction, >80% of them were satisfied with their sexual function [46].…”

“…Notably, significant increase in overall prevalence and severity of erectile dysfunction among our male hemodialysis patients during the COVID-19 pandemic is particularly important, given that erectile dysfunction is considered a surrogate marker of endothelial damage and an early marker for cardiovascular disease and predicts cardiovascular mortality [6,47,48]. In addition to being a distressing symptom in itself, erectile dysfunction has increasingly become recognized as a risk marker for potentially life-threatening cardiovascular disease events and premature death, including hemodialysis patients [6,49].…”

“…Both IIEF-5 (median [min-max] 10.5 vs. 7.5 [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23], p < 0.001) and FSFI (12 [4-78] vs. 6 [4-66], p < 0.001) scores significantly decreased during the pandemic (Table 2) along with increase in the likelihood of having erectile dysfunction (from 66.7% to 92.2% overall, from 49.0% to 60.7% for serious erectile dysfunction, p < 0.001) but no significant difference in prevalence of female sexual dysfunction (68.8% for both periods) (Figure 1). Median (min-max) BDI scores significantly increased during pandemic compared to pre-pandemic period (from 11 [0-42] to 17 , p < 0.001) (Table 2), along with significantly higher likelihood of having depression (63.1% vs. 75.0% overall, 19.0% vs. 33.3% for moderate-to-severe depression, p < 0.001) after the pandemic (Figure 1).…”

“…In addition, while being less-extensively studied than mental health issues in the hemodialysis population, the sexual dysfunction has also become increasingly recognized as a highly prevalent life stressor in male and female patients receiving maintenance dialysis therapy [5][6][7]. Indeed, presence of erectile dysfunction has been considered to be an independent mortality factor in patients on hemodialysis [6], while both anxiety and depression were reported to be significantly related to sexual dysfunction [2].…”