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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


Checked for plagiarism Yes

Review by Single anonymous peer review

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.
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.

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

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