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The relationship between hydration status, male sexual dysfunction and depression in hemodialysis patients

Authors Hassan K, Elimeleh Y, Shehadeh M, Fadi H, Rubinchik I

Received 30 July 2017

Accepted for publication 29 November 2017

Published 13 March 2018 Volume 2018:14 Pages 523—529

DOI https://doi.org/10.2147/TCRM.S147723

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Professor Garry Walsh


Kamal Hassan,1,2 Yotam Elimeleh,1 Mona Shehadeh,3 Hassan Fadi,4 Irina Rubinchik2

1Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel; 2Department of Nephrology and Hypertension, Galilee Medical Center, Nahariya, Israel; 3Biochemistry Laboratory, Galilee Medical Center, Nahariya, Israel; 4Internal Medicine Department E, Galilee Medical Center, Nahariya, Israel

Background: Disturbances in sexual function are common among dialysis patients. Normal erections require a complex balance of physiological, psychological, emotional, hormonal, neurological and vascular factors. This study examined a possible association of overhydration (OH) with male sexual dysfunction and depression in hemodialysis (HD) patients.
Patients and methods: This cross-sectional study assessed hydration status by whole-body bioimpedance spectroscopy in patients on maintenance HD for more than 12 months. Patients were categorized according to OH to extracellular water (ECW) ratio: OH/ECW ratio >0.15 and OH/ECW ratio ≤0.15. Sexual function was assessed using the International Index of Erectile Function (IIEF) score. Psychological status was evaluated using the Beck Depression Inventory (BDI) score. Serum sex hormones were determined.
Results:
Of 39 stable participants on HD, 53.8% were overhydrated (OH/ECW ratio >0.15) and 46.2% not overhydrated (OH/ECW ratio ≤0.15). Of participants with OH/ECW ratio >0.15, 85.7% had mild to severe ED, and 71.4% had abnormal BDI scores, ranging from mild mood disturbance to severe depression. Compared to patients with OH/ECW ratio ≤0.15, BDI scores, serum estradiol and plasma hsCRP were higher (18.48±8.34 vs 10.61±5.46, p<0.001; 140.10±44.51 vs 126.10±32.26, p=0.034; and, 17.70±12.14 vs 9.76±8.79, p=0.013; respectively) in those with OH/ECW ratio >0.15, while their IIEF score, serum total testosterone and dehydroepiandrosterone (DHEA) were lower (12.81±7.31 vs 41.44±23.79, p<0.001; 8.97±5.43 vs 14.10±8.30, p=0.013; and 85.31±55.14 vs 133.3±95.48, p=0.029; respectively). The OH/ECW ratio correlated inversely with the IIEF score (r=-0.69, p<0.001) and positively with BDI scores (r=0.64, p<0.001). IIEF scores were inversely correlated with BDI scores (r=-0.54, p<0.001).
Conclusion: OH in HD patients was found to be associated with a higher prevalence of sexual dysfunction and depression, lower serum levels of total testosterone and DHEA, and higher levels of serum estradiol.

Keywords:
hemodialysis, overhydration, erectile dysfunction, depression, sex hormones, International Index of Erectile Function score, Beck Depression Inventory score

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