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101. Treatment options for sexual dysfunction in patients with chronic kidney disease: a systematic review of randomized controlled trials

Author

Sankar D. Navaneethan, Emmanuele A. Jannini, Giuseppe Lucisano, David W. Johnson, Mariacristina Vecchio, Giusi Graziano, Marialuisa Querques, Giovanni F.M. Strippoli, Carmen Bonifati, Valeria Saglimbene, and Marinella Ruospo

Subjects
Adult, Male, medicine.medical_specialty, Epidemiology, Phosphodiesterase Inhibitors, Female sexual dysfunction, Placebo-controlled study, Administration, Oral, Critical Care and Intensive Care Medicine, Placebo, urologic and male genital diseases, law.invention, Randomized controlled trial, Erectile Dysfunction, law, Internal medicine, Medicine, Humans, Testosterone, Randomized Controlled Trials as Topic, Cyclic Nucleotide Phosphodiesterases, Type 5, Transplantation, Evidence-Based Medicine, business.industry, Original Articles, Luteinizing Hormone, Middle Aged, Phosphodiesterase 5 Inhibitors, medicine.disease, female genital diseases and pregnancy complications, Clinical trial, Sexual Dysfunction, Physiological, Zinc, Erectile dysfunction, Sexual dysfunction, Treatment Outcome, Nephrology, Chronic Disease, Dietary Supplements, Physical therapy, Female, Follicle Stimulating Hormone, Human, Kidney Diseases, medicine.symptom, business, Biomarkers, Kidney disease
Abstract

Background and objectives: Sexual dysfunction is very common in patients with chronic kidney disease (CKD), but treatment options are limited. The benefits and harms of existing interventions for treatment of sexual dysfunction were assessed in patients with CKD. Design, setting, participants, & measurements: MEDLINE (1966 to December 2008), EMBASE (1980 to December 2008), and the Cochrane Trial Registry (Issue 4 2008) were searched for parallel and crossover randomized and quasi-randomized trials. Treatment effects were summarized as mean differences (MD) or standardized mean difference (SMD) with 95% confidence intervals (CI) using a random effects model. Results: Fourteen trials (328 patients) were included. Phosphodiesterase-5 inhibitors (PDE5i) compared with placebo significantly increased the overall International Index of Erectile Function-5 (IIEF-5) score (three trials, 101 patients, MD 1.81, 95% CI 1.51 to 2.10), all of its individual domains, and the complete 15-item IIEF-5 (two trials, 80 patients, MD 10.64, 95% CI 5.32 to 15.96). End-of-treatment testosterone levels were not significantly increased by addition of zinc to dialysate (two trials, 22 patients, SMD 0.19 ng/dl, 95% CI −2.12 to 2.50), but oral zinc improved end-of-treatment testosterone levels. There was no difference in plasma luteinizing and follicle-stimulating hormone level at the end of the study period with zinc therapy. Conclusions: PDE5i and zinc are promising interventions for treating sexual dysfunction in CKD. Evidence supporting their routine use in CKD patients is limited. There is an unmet need for studying interventions for male and female sexual dysfunction in CKD considering the significant disease burden.

Published
2010

102. Dépression et mortalité cardiovasculaire en hémodialyse : une étude de cohorte multinationale

Author

Patrizia Natale, M. Scaldapane, J.C. Craig, P. Stroumza, V. Saglimbene, L. Gargano, L. Frantzen, Suetonia C. Palmer, J. Dulawa, Giovanni F.M. Strippoli, Marinella Ruospo, and Angelo M. Murgo

Subjects
Nephrology
Abstract

Introduction La depression est frequente chez les adultes en dialyse avec une prevalence d’environ 25 %. Des etudes montrent un lien entre la depression et la mortalite totale, mais l’association entre la depression et la mortalite cardiovasculaire est incertaine. Patients et methodes Nous avons etudie une cohorte multinationale prospective portant sur les adultes traites par hemodialyse iterative au sein d’un reseau mondial entre avril et novembre 2010. La depression a ete etudiee grâce au Beck Depression Inventory (BDI) II. Les tests de sensibilite considerent un BDI II ≥ 14 pour deceler une depression et BDI II ≥ 20 pour affirmer une depression severe. Le modele de regression de Cox a ete utilise pour evaluer les risques ajustes pour toutes causes et la mortalite cardiovasculaire a 12 mois. Resultats Parmi les 2278 (73 %) participants qui ont fourni des reponses completes aux questions de l’enquete BDI II, 1047 (46 %) des repondants ont signale des symptomes correspondant a la depression. Discussion Les facteurs associes a des symptomes depressifs comprenaient l’âge, le pays, l’emploi, l’education, le tabagisme, la comorbidite cardiovasculaire, la pression arterielle, la dose de dialyse et la prise de medicaments psychoactifs. Au cours du suivi de 11 mois (± 2,5), 175 deces sont survenus, dont 66 etaient attribuables a des causes cardiovasculaires. La depression (BDI ≥ 14) n’etait pas associee a la mortalite toutes causes confondues (HR ajuste 1,26 [IC 95 % de 0,93 a 1,71]) ou a la mortalite cardiovasculaire (0,82 [0,50 a 1,34]). Quand un score plus eleve (BDI ≥ 20) a ete utilise pour identifier la depression, la depression etait associee a une mortalite globale (1,40 [1,02 a 1,93]), tandis qu’une association avec la mortalite cardiovasculaire n’etait pas evidente (1,05 [0,63 a 1,77]). Conclusion La relation entre la depression et la mortalite cardiovasculaire chez les adultes traites par hemodialyse est incertaine. Les liens actuels entre la depression et les causes de mortalite sont influences par les parametres et les seuils utilises pour identifier les symptomes depressifs.

Published
2015
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103. Dysfonction sexuelle chez les femmes traitées par hémodialyse : une étude transversale multinationale

Author

G. Strippoli, D. Del Castillo, J.C. Craig, Marco Scaldapane, Miguel C. Leal, Patrizia Natale, Paul Stroumza, Marinella Ruospo, V. Saglimbene, Luc Frantzen, Ruben Gelfman, and Suetonia C. Palmer

Subjects
Nephrology
Abstract

Introduction La dysfonction sexuelle est tres repandue chez les femmes atteintes de maladies renales chroniques avec une prevalence d’environ 80 %. Nous avons cherche a evaluer les correlations des differents domaines de la fonction sexuelle (desir, l’excitation, lubrification, orgasme, satisfaction et douleur) chez les femmes traitees par hemodialyse. Patients et methodes Nous avons mene une etude multinationale, transversale chez les femmes traitees par hemodialyse iterative au sein d’un reseau de dialyse en Europe et en Amerique du Sud. La fonction sexuelle de la femme a ete evaluee grâce au questionnaire : Female Sexual Function Index (FSFI). Les scores les plus faibles representaient une plus grande dysfonction sexuelle. Les correlations de chaque domaine ont ete identifiees par regression lineaire multivariee. Seules les femmes qui ont declare etre sexuellement actives ont ete incluses. Resultats Sur 1309 femmes, 659 (50,3 %) ont fourni des reponses completes au FSFI. Les femmes en liste d’attente pour une greffe renale et celles avec un partenaire ont les scores plus eleves. Les femmes souffrant d’hypertension ou menopausees ont les scores plus faibles. Discussion Les patientes avec un traitement antihypertenseur associent une hausse des scores pour l’excitation, la lubrification et l’orgasme respectivement [variation moyenne (IC 95 %) de 0,37 (de 0,09 a 0,66), 0,35 (0,01 a 0,68), 0,35 (0,01 a 0,68)]. Les femmes recevant des medicaments anxiolytiques ont rapporte moins de douleur [−0,40 (−0,01 a −0,80−)] et de desir [−0,20 (−0,41− a 0)]. Les femmes moins instruites ont rapporte des niveaux inferieurs d’excitation, de lubrification et d’orgasme. Chez les femmes declarant etre sexuellement actives (n = 232) les symptomes depressifs ont ete associes a des scores plus faible. Conclusion Les femmes traitees par dialyse rapportent des experiences differentes de la dysfonction sexuelle en lien avec l’education, la depression et traitement de l’anxiete. Les comorbidites peuvent egalement jouer un role dans la fonction sexuelle. Ces donnees suggerent qu’une etude plus approfondie de l’impact de la dysfonction sexuelle sur le bien-etre du patient en dialyse est justifiee.

Published
2015
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104. SP701DEPRESSIVE SYMPTOMS AND EARLY ALL−CAUSE AND CARDIOVASCULAR MORTALITY IN HEMODIALYSIS PATIENTS: A MULTINATIONAL COHORT STUDY

Author

Patrizia Natale, Tevfik Ecder, Jörgen Hegbrant, Jan Duława, Staffan Schön, Charlotta Wollheim, Marco Scaldapane, Miguel C. Leal, Paul Stroumza, Suetonia C. Palmer, Jonathan C. Craig, Valeria Saglimbene, Anna Bednarek-Skublewska, Giovanni F.M. Strippoli, Marinella Ruospo, Letizia Gargano, and Angelo M. Murgo

Subjects
Transplantation, medicine.medical_specialty, Nephrology, business.industry, Internal medicine, medicine.medical_treatment, medicine, Hemodialysis, business, All cause mortality, Cardiovascular mortality, Cohort study
Published
2015
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105. FP706PHARMACOLOGICAL INTERVENTIONS FOR DEPRESSION IN ADULTS WITH END-STAGE KIDNEY DISEASE

Author

Giovanni F.K. Strippoli, Patrizia Natale, Jonathan C. Craig, Suetonia C. Palmer, Marinella Ruospo, Kannaiyan S Rabindranath, and Valeria Saglimbene

Subjects
Transplantation, medicine.medical_specialty, Nephrology, business.industry, Internal medicine, Psychological intervention, Medicine, business, End-stage kidney disease, Depression (differential diagnoses)
Published
2015
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106. SP748PERIODONTITIS AND EARLY MORTALITY IN ADULTS WITH KIDNEY FAILURE TREATED WITH HEMODIALYSIS: A MULTINATIONAL OBSERVATIONAL STUDY

Author

Jonathan C. Craig, Patrizia Natale, Michele De Benedittis, Pauline J. Ford, Marcello Tonelli, Germaine Wong, Massimo Petruzzi, Valeria Saglimbene, David W. Johnson, Fabio Pellegrini, FM Giovanni, Suetonia C. Palmer, Marinella Ruospo, and Jörgen Hegbrant

Subjects
Periodontitis, Transplantation, Kidney, medicine.medical_specialty, business.industry, medicine.medical_treatment, medicine.disease, medicine.anatomical_structure, Nephrology, medicine, Observational study, Hemodialysis, Intensive care medicine, business
Published
2015
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113. Oral disease in adults treated with hemodialysis: prevalence, predictors, and association with mortality and adverse cardiovascular events: the rationale and design of the ORAL Diseases in hemodialysis (ORAL-D) study, a prospective, multinational, longitudinal, observational, cohort study

Author

Juan Nin Ferrari, Pauline J. Ford, David W. Johnson, Valeria Saglimbene, Fabio Pellegrini, Paul Stroumza, Jörgen Hegbrant, Charlotta Wollheim, Letitzia Gargano, Jan Duława, Domingo Del Castillo, Suetonia C. Palmer, Ruben Gelfman, Patrizia Natale, Michele De Benedittis, Luc Frantzen, Anna Bednarek-Skublewska, Marietta Török, Jonathan C. Craig, Eduardo Celia, Giovanni F.M. Strippoli, Miguel Leal, Marinella Ruospo, and Massimo Petruzzi

Subjects
Nephrology, Adult, medicine.medical_specialty, Internationality, medicine.medical_treatment, Population, Oral Health, Oral hygiene, Cohort Studies, Study Protocol, Predictive Value of Tests, Renal Dialysis, Risk Factors, Internal medicine, Chronic kidney disease, Surveys and Questionnaires, medicine, Prevalence, Humans, Longitudinal Studies, Prospective Studies, Mortality, Prospective cohort study, education, Periodontitis, Dialysis, education.field_of_study, business.industry, Oral disease, South America, medicine.disease, Europe, Treatment Outcome, Cardiovascular Diseases, Kidney Failure, Chronic, Hemodialysis, business, Mouth Diseases, Cohort study, Kidney disease, Follow-Up Studies
Abstract

Background People with end-stage kidney disease treated with dialysis experience high rates of premature death that are at least 30-fold that of the general population, and have markedly impaired quality of life. Despite this, interventions that lower risk factors for mortality (including antiplatelet agents, epoetins, lipid lowering, vitamin D compounds, or dialysis dose) have not been shown to improve clinical outcomes for this population. Although mortality outcomes may be improving overall, additional modifiable determinants of health in people treated with dialysis need to be identified and evaluated. Oral disease is highly prevalent in the general population and represents a potential and preventable cause of poor health in dialysis patients. Oral disease may be increased in patients treated with dialysis due to their lower uptake of public dental services, as well as increased malnutrition and inflammation, although available exploratory data are limited by small sample sizes and few studies evaluating links between oral health and clinical outcomes for this group, including mortality and cardiovascular disease. Recent data suggest periodontitis may be associated with mortality in dialysis patients and well-designed, larger studies are now required. Methods/design The ORAL Diseases in hemodialysis (ORAL-D) study is a multinational, prospective (minimum follow-up 12 months) study. Participants comprise consecutive adults treated with long-term in-center hemodialysis. Between July 2010 and February 2012, we recruited 4500 dialysis patients from randomly selected outpatient dialysis clinics in Europe within a collaborative network of dialysis clinics administered by a dialysis provider, Diaverum, in Europe (France, Hungary, Italy, Poland, Portugal, and Spain) and South America (Argentina). At baseline, dental surgeons with training in periodontology systematically assessed the prevalence and characteristics of oral disease (dental, periodontal, mucosal, and salivary) in all participants. Oral hygiene habits and thirst were evaluated using self-administered questionnaires. Data for hospitalizations and mortality (total and cause-specific) according to baseline oral health status will be collected once a year until 2022. Discussion This large study will estimate the prevalence, characteristics and correlations of oral disease and clinical outcomes (mortality and hospitalization) in adults treated with dialysis. We will further evaluate any association between periodontitis and risk of premature death in dialysis patients that has been suggested by existing research. The results from this study should provide powerful new data to guide strategies for future interventional studies for preventative and curative oral disease strategies in adults who have end-stage kidney disease.

Published
2013

114. The beliefs and expectations of patients and caregivers about home haemodialysis: an interview study

Author

Måns Olsson, Jörgen Hegbrant, Letizia Gargano, Steven Fishbane, Braden Manns, Jonathan C. Craig, Suetonia C. Palmer, Giovanni F.M. Strippoli, Marinella Ruospo, David W. Johnson, and Allison Tong

Subjects
Isolation (health care), media_common.quotation_subject, 030232 urology & nephrology, Peer support, 03 medical and health sciences, 0302 clinical medicine, Nursing, Respite care, Health care, Medicine, 030212 general & internal medicine, Qualitative Research, media_common, Renal Medicine, business.industry, Research, General Medicine, 3. Good health, Thematic analysis, Direct experience, business, Autonomy, Qualitative research
Abstract

Objectives To explore the beliefs and expectations of patients and their caregivers about home haemodialysis in Italy where the prevalence of home haemodialysis is low. Design Semistructured, qualitative interview study with purposive sampling and thematic analysis. Setting Four dialysis centres in Italy without home haemodialysis services (Bari, Marsala, Nissoria and Taranto). Participants 22 patients receiving in-centre haemodialysis and 20 of their identified caregivers. Results We identified seven major themes that were central to patient and caregiver perceptions of home haemodialysis in regions without established services. Three positive themes were: flexibility and freedom (increased autonomy, minimised wasted time, liberation from strict dialysis schedules and gaining self-worth); comfort in familiar surroundings (family presence and support, avoiding the need for dialysis in hospital) and altruistic motivation to do home haemodialysis as an exemplar for other patients and families. Four negative themes were: disrupting sense of normality; family burden (an onerous responsibility, caregiver uncertainty and panic and visually confronting); housing constraints; healthcare by ‘professionals’ not ‘amateurs’ (relinquishing security and satisfaction with in-centre services) and isolation from peer support. Conclusions Patients without direct experience or previous education about home haemodialysis and their caregivers recognise the autonomy of home haemodialysis but are very concerned about the potential burden and personal sacrifice home haemodialysis will impose on caregivers and feel apprehensive about accepting the medical responsibilities of dialysis. To promote acceptance and uptake of home haemodialysis among patients and caregivers who have no experience of home dialysis, effective strategies are needed that provide information about home haemodialysis to patients and their caregivers, assure access to caregiver respite, provide continuous availability of medical and technical advice and facilitate peer patient support.

Published
2013
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120. Epidemiology and outcome - 1

Author

Bradford Strijack, Manish M. Sood, Mohamed Zaki, Yoshihide Fujigaki, Alfonso M. Cueto-Manzano, K.S. Nayak, Jacques Bildet, Raymond D. Pratt, Tee Chau Keng, Yukitoshi Sakao, Akira Hishida, Anna Casula, Francesco Rossa, Yoshitaka Isaka, Pilar Martinez, Carla Estremadoyro, Maryam Sharifian, Ruth Da Silva, Kenichiro Iio, Miriam Alvo, Yvonne Jeanes, Stephanie Stringer, Julie Mojica, B. Roszkowiak, Giada Bernabini, Svjetlana Čala, D. Drobnik, Graham Warwick, Mariusz Kusztal, Margarita Velkova, Tilman B. Drüeke, Beatriz Leimman, Victor Andreucci, A. Kaczmarek, Raffaele Caprioli, Yoko Kato, Enzo Corghi, Akihiko Kato, Li Ping Tan, Valery Pilotovich, Joelle Cridlig, Chew Ming Wong, Marcelo Bastos, Rasha Elfar, Pavlina Dzekova-Vidimliski, F. Mallamaci, Leticia Elgueta, Alicia Fernandez, Alireza Shekariyan, Marco Pignocco, Sepideh Amirifard, Giuseppe Bueti, Gilbert Deray, Marian Klinger, Fergus Caskey, Adriano Casela, V. Leki, Rachel Bregman, Jalal Etemadi, Tomoaki Fujioka, Hiraku Kadoguchi, Suma Prakash, S. Cutrupi, Juan Antonio Quiroga, Carole Loos-Ayav, Emilio Glez Parra, Leigh Gibson, María Eugenia Sanhueza, Yip Boon Chong, A. Grzegorzewska, Juan J. Cruz, Yoko Takeda, Lennize Pereira Paulo, Mohammadreza Ardalan, Antonio R. Vilches, Gustavo Laham, Nicole Larroumet, Yosuke Fujishima, J. Wojciechowski, Silvio Bertoli, Minako Wakasugi, Antonio Nicolucci, Corinne Isnard Bagnis, Dina Khawnekar, Toshiyuki Onoda, N. P. Singh, Arben Asani, G. Nisiewicz, Kazuyoshi Itai, Mohammad Moujerloo, Ugo Teatini, Carlos H. Díaz, Jose Maria Alcazar de la Osa, Masaaki Inaba, Motoko Tanaka, Yasuyuki Nagasawa, Luc Frimat, Peter Rutherford, Toshiyuki Ojima, R. Kohli, Katarzyna Babska, Luca E. Bernardi, Vili Amitov, Mehdi Tazhibi, Susan Crail, Mirfarhad Ghalehbandi, Sabrina Valle, Afsoon Emami Naeini, Ammar Tabikh, Louise Moist, Ahmed Belal, Giuliano Barsotti, Jorgen Hegbrant, Ryohei Yamamoto, Laura Cortés-Sanabria, Claudio Pozzi, Michał Nowicki, Giulietta Sbragia, Si Yen Tan, Sakumi Kazama, Hirotsugu Iwatani, Mohan Sathyanarayanan, Ajmal Younis, Hanna Augustyniak Bartosik, J. Molenda, Jamshid Roozbeh, Mario Espinosa, Rakesh S. Patel, Manuel Arias, Palepu B Gopal, Vicente Carreño, Paul Komenda, Michio Umezu, Silvia Furiani, Sanaz Shabani, Stefano De Pietro, Hristo Shivarov, Pinggao Zhang, Leticia Krauss, J. Zachwieja, J. Sobolewski, Valeria Maria Saglimbene, Masaki Ohsawa, Umezurike Okafor, Delfina Costa, Matthew Howse, Daniele Hue, Fumio Endo, Tomasz Gołębiowski, Saghafi Sharareh, Gérard M. London, J. Waszczuk, Dolores Arenas, Aurelio Limido, Mariacristina Vecchio, Rubén Torres, Catherine Tourette Turgis, D. Firlej, Ahmad Gahanizadeh, Mohammadali Mohajel Shoja, Gulsen Selim, Wacław Weyde, Enyu Imai, Asheesh Sharma, Ines Held, Suzanne Stewart, Vincenzo Panichi, C. Marino, Jean-Louis Bouchet, Manish Gautam, Anteo Di Napoli, Paul Lawton, Héctor R. Martínez-Ramírez, Saso Gelev, D. Frankiewicz, Marco Pozzi, A Casolaro, Senji Okuno, Marcin Tkaczyk, Yoshiyuki Furumatsu, Yoshiki Nishizawa, Rodolfo Rodriguez, Aleksandar Sikole, Udaya Udayaraj, Hubert Roth, Eiji Ishimura, Angel L.M. de Francisco, Maud Grimault, Nicolas Peters, Sankar D. Navaneethan, Sara Llorente, Sabrina Paoletti, Juan Gracia-Valdecasas, Keiji Kono, M. Postorino, Eloy Fernandez, Carlo Donadio, Michèle Kessler, Cristina Consani, Gianna D'Adamo, Domenico Di Lallo, Kimitoshi Nakamura, Antonella Costantino, Senussi Elbeshti, Ankur Gupta, F. Mattace-Raso, Serena Chicca, Wai Yew Kong, Takaya Abe, Kiyomi Sakata, Peter C. Austin, Sayed Hossein Hejazi, Brunella Andreini, Anindita Chowdhury, Martine Giraud, Dan Roberts, Investigators, Jyoti Baharani, Shunsuke Goto, Claudio Rigatto, Magdalena Krajewska, W. Ratajewski, Vincenzo De Cristofaro, David Ansell, Ewa Trafidlo, Kozo Tanno, Masafumi Fukagawa, Marinella Ruospo, Hiromi Rakugi, Aurelie Untas, Laeticia Idier, Fumi Horiguchi, Paul Roderick, Blanca Casale, A. Swiderski, Ali Hashemi, George Hranov, Mayoor V. Prabhu, Lisa A. Rocca Rey, Javier Bartolome, C. Zoccali, Lucile Mercadal, Akira Okayama, Yoshifumi Maeno, Giovanni F.M. Strippoli, Tatsuya Shoji, Pedro Sfeir, Vinay Kumar Saini, Ana María Cusumano, Ruben Ayala, Ichiei Narita, Nikola Stojcev, Alejandro Pacheco, Philippe Chauveau, Patrizio Pezzotti, Jose Carlos Diaz Bailon, Hideki Fujii, Carmen Sanchez, Patrik Finne, Deven Juneja, Atif Mohiuddin, Halima Resić, L. Niepolski, Guillermina Barril, Ewerton Roberto, Su Hooi Teo, Dulce Lessi, M. Kicki, Alberto Lippi, Charles R.V. Tomson, Boris Bikbov, Enisa Mesic, J. Witteman, Ryuichiro Konda, Shahrzad Shahidi, Tetsuari Onishi, Graeme L. Close, E Mantuano, Denis Fouque, Cosimo Spinelli, Rosamund Wilson, Innocent Ekwem, G. Tripepi, Diego Brancaccio, Osama El-Minshawy, Natalia Tomilina, Yoav Ben-Shlomo, Hirotaka Komaba, Tomoyuki Fujikura, Osamu Uchikoga, Mehdi Azami, Gervasio Soler Pujol, Karen Kato, Keevin Bernstein, Luca Neri, Lada Trajceska, Giuseppe Pontoriero, Khairi Ayad, Yumi Ito, Nuria Garcia Fernandez, Junichiro James Kazama, Galina Severova-Andreevska, Mario Davalos, P. Pizzini, Virginia Aielli, Soo Kun Lim, Sara Beati, Sreepada Subhramanyam, Inmaculada Castillo, Valentina Marchetti, Boriana Delijska, Ann M. O’Hare, and Carola Grönhagen-Riska

Subjects
Transplantation, medicine.medical_specialty, Nephrology, business.industry, Epidemiology, medicine, Intensive care medicine, business, Outcome (game theory)
Published
2009
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121. Epidemiology and outcome - 2

Author

Peter Bárány, F. Lladós, Gisela Sturm, Andrea Remuzzi, Brenda W. Gillespie, John L. Griffith, Abdul Rashid Qureshi, Heinz Jürgen Roth, Peter Stenvinkel, H.C. Rayner, Glenn M. Chertow, Anna Bednarek, Tiziana Di Paolantonio, Patricia de Sequera, Simona Hogas, Ray Krediet, J.A. Kellum, Piero Ruggenenti, F. Nurhan Ozdemir, Maria Concetta Vaccaro, Hiroko Inagaki, Ausilia Maione, Hal Morgenstern, Paolo Parini, Asta Auerbach, Jana Smrzova, Muhammad Shahed Ahmed, Daniel Rajdl, Mônica Viegas Andrade, Emanuel Zitt, Karen Amar, Véronique Joyeux, L. Weissfeld, Cacia Mendes Matos, David M. Kent, Marta Lugo, Marit Jordhoy, A. Martín-Malo, Odilon Vanni de Queiroz, Márcia Tereza Silva Martins, Maurice Alan Brookhart, Navdeep Tangri, A. Casula, Maria Luisa Lozano, Francesco Locatelli, Ursula Caceres, Jorgen Hegbrant, Shouichi Fujimoto, Antonio Nicolucci, Dulce Nicolas, K. Pitcher, Matthew Howse, Isabel Cristina Gomes, X. Cuevas, Nathan W. Levin, J. Fort, Antonio Piccoli, Shigehiro Uezono, Mark R. Marshall, Gordon Prescott, F.K. Port, Keith Simpson, Tomislav Bozek, Taina Lara Campos Cordeiro Valadares, Günter Edenharter, Toril Dammen, Kellie Hunter Campbell, Fabio Pellegrini, J. Lozano, Catherine Vérove, Jennifer Ennis, Claudia Barth, Mostapha Elallam, Michal Vostry, M. Unruh, Jaroslav Racek, Nistor Ionut, Nicole Stankus, Jaromír Eiselt, Milan Petrovic, Bolesław Rutkowski, lle Pechter, Cécile Couchoud, D.J. de Jager, Paul M. Just, R. Pérez-García, Yoav Ben-Shlomo, Lucia Guidotti, Karl Lhotta, Nicola Palmieri, Graciela Voronovitsky, William Dale, Merike Luman, Christoph Wanner, B.M. Robinson, Daniel Resende Faleiros, Paul Stroumza, Robert Mactier, C. Argyropoulos, Ognjenka Djurdjev, Kevan R. Polkinghorne, Juan Nin Ferrari, Bruce G. Robinson, Gelfman Ruben, Naoko Ikeda, Elviira Seppet, David Ansell, Marion Verduijn, Kirsten Haas, Bengt Lindholm, Jan Dulawa, Marcello Tonelli, Olof Heimbürger, E.W. Boeschoten, Juan Jesus Carrero, Adeera Levin, Dina Montasser, Gildete Barreto Lopes, Omar Maoujoud, Agostino Naso, Luminita Voroneanu, Paul Gusbeth-Tatomir, Brian D. Bradbury, Seema Sondhi, Margit Muliin, Valjbona Prelevic, Pierre Donnadieu, Giovanni F.M. Strippoli, Diana C. Grootendorst, Ingrid Os, Bogdan Ene-Iordache, Lada Malanova, Sergio Carminati, Keiko Kodama, J. Gilg, Mario Plebani, Inga Mandac, Sebnem Karakan, Pajica Pavkovic, Seiichiro Hara, Pedro Trinidad, Olga Sergeyeva, Oscar Bracchi, Yassir Zajari, Mohammed Hassani, Jonathan Bazeley, F. Tentori, Hans-Jürgen Schober-Halstenberg, Inger Hilde Nordhus, Mathilde Lassalle, Akira Saito, Marietta Torok, Ingrid Prkacin, Külli Kõlvald, Valjbona Preljevic, Yun Li, Martin Wagner, Ulrich Neyer, Elisabeth Reiss, Alberto Menegotto, Hannelore Sprenger-Mähr, Siiri Mesikepp, Vidojko Djordjevic, Marianna Zsom, Luis Espejo, Siren Sezer, Friedrich K. Port, Naser Tayebi, Mohammed Alayoud, Antonio Alberto Lopes, Simon Sawhney, Ruben Lopez, Augusto Afonso Guerra Junior, R.L. Pisoni, Stephen McDonald, Abdelali Bahadi, Shunichi Fukuhara, Gero von Gersdorff, Bruno Saligari, Zouhir Oualim, Alexandra Kitazawa, Marinella Ruospo, Mohammed Asseraji, Jorge Velez, Mathias Schaller, Lin Tong, Cesar Cruzalegui, Stevan Glogovac, Monserrat Morales, Peter C. Thomson, Alison M. MacLeod, M. Heaton, Nicola D'Ambrosio, Felipe Vazquez, A. Hodsman, Michał Chmielewski, F.W. Dekker, David R. Walker, Ronald L. Pisoni, H. Morgenstern, Martin Gomez, Charles R.V. Tomson, Letizia Gargano, Jamie P. Traynor, Anca Seica, Len A. Usvyat, Michela Sciancalepore, Jun Liu, Rolfdieter Krause, Francisco de Assis Acurcio, M.J. Blayney, M.E. Roumelioti, J. Davies, Bénédicte Stengel, Emmanuel Villar, Alan M. Brookhart, Carolyn Hunter, Catherine Wall, Tone Hortemo sthus, Adrian Covic, Michel Labeeuw, Peter Kotanko, Marco Murgo, P.G. Kerr, Stefan Arver, Moncef Kadiri, Giuseppe Remuzzi, Bertha Martinez, Ulrich Frei, Maria Lucia Sambati, R.T. Krediet, Paul Roderick, Y.Z. Shah, Florian Kronenberg, Taoufiq Aatif, Madis Ilmoja, Liliana Pinelli, Luc Frimat, Giovanni Cancarini, Ferruccio Conte, Wolfgang C. Winkelmayer, F. García, Rinaldo Di Toro Mammarella, Ronan Cunningham, Ermelinda Santiago, Giuseppe Accogli, Luciana Gravellone, Carmen Bonifati, Mihai Onofriescu, Eli Iola Gurgel Andrade, Friederike Lins, Els Boeschoten, A. Cheung, Michel Jadoul, Elaheh Dashti, Dolapo Ayansina, Monica Maria Mion, Edoardo Celia, Julio Gomez, Aleksander Lõhmus, Inger K. Laegreid, Eberechi Sandra Agwa, Ladislav Trefil, Friedo W. Dekker, Anna Casula, Austin G. Stack, Norberto Perico, Brian Bieber, George Mellotte, Mai Rosenberg, Hoang Nguyen, Conrad A. Baldamus, Daniele Araújo Campos Szuster, Abbas Ali Zeraati, Marta Codognotto, Tomáš Urbánek, Otto Freistätter, Alessandra Maciel Almeida, Massih Naghibi, and Stephan Thijssen

Subjects
03 medical and health sciences, Transplantation, medicine.medical_specialty, 0302 clinical medicine, Nephrology, business.industry, Epidemiology, 030232 urology & nephrology, medicine, Intensive care medicine, business, Outcome (game theory)
Published
2009
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122. Interventions for treating sexual dysfunction in patients with chronic kidney disease

Author

Emmanuele A. Jannini, Valeria Saglimbene, Giuseppe Lucisano, Giovanni F.M. Strippoli, Giusi Graziano, Sankar D. Navaneethan, David W. Johnson, Marialuisa Querques, Marinella Ruospo, and Mariacristina Vecchio

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Female sexual dysfunction, Cochrane Library, Placebo, Chlorides, Erectile Dysfunction, Renal Dialysis, Internal medicine, medicine, Humans, Vitamin E, Testosterone, Pharmacology (medical), Vitamin D, Bromocriptine, Dialysis, Randomized Controlled Trials as Topic, business.industry, Testosterone (patch), Vitamins, Phosphodiesterase 5 Inhibitors, medicine.disease, Sexual Dysfunction, Physiological, Zinc, Sexual dysfunction, Zinc Compounds, Meta-analysis, Chronic Disease, Physical therapy, Female, Kidney Diseases, medicine.symptom, business, Kidney disease
Abstract

Background Sexual dysfunction is very common in patients with chronic kidney disease (CKD), but it is still significantly understudied. Treatment options exist but concerns have been raised relating to their efficacy and safety in CKD. Objectives We assessed the benefits and harms of existing interventions for treatment of sexual dysfunction in patients with CKD. Search methods In October 2010 we searched the Cochrane Renal Group's specialised register, CENTRAL (The Cochrane Library, issue 10), MEDLINE (from 1966) and EMBASE (from 1980). Selection criteria Randomised controlled trials (RCTs) and quasi-RCTs of any pharmacological and non-pharmacological interventions used to treat sexual dysfunction in male and female CKD patients (predialysis, dialysis and kidney transplant) were included. Data collection and analysis Two authors independently selected eligible studies, extracted data and assessed study quality. Disagreements were resolved in consultation with an arbitrator. Treatment effects were summarised as risk ratios (RR), mean differences (MD) or standardised mean difference (SMD) with 95% confidence intervals (CI) using a random-effects model. Main results Fifteen studies (8 parallel, 7 crossover; 352 patients) were included. Only one study enrolled women. Studies evaluated the effects of phosphodiesterase-5 inhibitors (PDE5i), zinc, vitamin E, vitamin D or bromocriptine compared to placebo. PDE5i significantly increased the overall International Index of Erectile Function-5 (IIEF-5) score (2 studies, 101 patients, MD 10.65, 95% CI 5.34 to 15.96), all its individual domains and the complete 15-item IIEF tool (1 study, 41 patients, MD 2.64, 95% CI 1.32 to 3.96). End of treatment testosterone levels were not significantly increased by addition of zinc to dialysate (2 studies, 22 patients, MD 0.21 ng/mL, 95% CI -2.14 to 2.55) but oral zinc improved end of treatment testosterone levels (1 study, 20 patients, SMD 1.62, 95% CI 0.58 to 2.66). There was no difference in plasma luteinizing and follicle-stimulating hormone levels at the end of the study period with zinc therapy. Only sparse data were available for vitamin E, bromocriptine and dihydroxycholecalciferol in CKD patients and there were no studies of intracavernous injections, transurethral injections, mechanical devices or psychosexual therapies in people with CKD. Authors' conclusions PDE5i and zinc are promising interventions for treating sexual dysfunction in men with CKD. Evidence supporting their routine use in CKD patients is limited. There is an unmet need for studying interventions for both male and female sexual dysfunction in CKD, considering the significant disease burden.

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