Sex hormones and erectile dysfunction in hemodialysis patients

To determine the prevalence of Erectile Dysfunction [ED] in hemodialysis patients [HD] and to study the associated changes in sex hormones in these patients. This is a hospital based cross sectional study conducted at hemodialysis units of Shalamar and Mayo Hospitals, Lahore from January to March 2008. All male patients with ESRD on maintenance [HD], whose spouses were alive and able to perform intercourse, were included in the study. Patients with cognitive and communication deficits were excluded from study. International index of erectile function-5[IIEF-5], adopted in Urdu was used for determination of prevalence of ED. Demographic data was collected and sex hormones [total testosterone, Dihydroepiandrosteronediones [DHEA], Follicle Stimulating Hormone [FSH], Leutinizing Hormone [LH] and serum Prolactin] were measured. A total number of fifty patients were included in the study. The major cause of ESRD was diabetes mellitus 28 [56%]. The prevalence of ED was 86% with a mean IIEF-5 score 10.36 +/- 7.13. The majority of patients, 33 [66%], were suffering from a severe degree of ED. The total testosterone level was low in 30 [60%] patients and DHEA were low normal in most of patients, 46 [92%]. Compared to patients with non-ED, those with ED had a significantly lower DHEA [1.93 +/- 0.73 vs 0.81 +/- 0.11, p value = 0.007]. Total testosterone and DHEA had a negative correlation with age and diabetes mellitus. FSH showed a variable response in these patients, it was low [< 1.55 mIU/ml] in three, normal [1.55 +/- 9.74 mIU/ml] in 39 and high [> 9.74 mIU/ml] in eight patients. LH was low [< 1.2 mIU/ml] in two, normal [1.2 +/- 7.8 mIU/ml] in thirty three and high [> 7.8 mIU/ml] in fifteen patients. FSH and LH showed a positive correlation with duration of dialysis. Prolactin level was low in 21[42%] patients. Total testosterone, FSH, LH and Prolactin had no association with ED. The majority of the patients suffering from ESRD, on maintenance HD had ED. DHEA was significantly lower in patients with ED, compared to those with no-ED. Total testosterone and DHEA had an inverse relationship with diabetes and age of the patients. Total testosterone, FSH, LH and prolactin did not affect erectile function

Depression in hemodialysis patients

To measure the frequency of depression and its risk factors in patients under going hemodialysis. It is a cross-sectional prospective study conducted at Hemodialysis unit of Shalamar Hospital and Shaikh Zayed Hospital, Lahore from 1[st] January 2006 to 30[th] April 2006. All patients getting regular hemodialysis for more than three months were included. Beck's Depression Inventory- II [BDI-II; adapted in Urdu] was administered on all the patients who were able to read or understand it. Blood sample were drawn at the same time for routine hematological, biochemical parameters and viral markers [Anti HCV and HbsAg]. Diagnosis was made as per Diagnostic and Statistical Manual of Mental Disorders, fourth edition [DSM IV] for correlation of psychological variables with clinical, hematological and biochemical parameters. Eighty nine patients were enrolled which included fifty two [58.4%] were male and seventy seven [86.5%] were married. Major causes of renal failure were diabetes, hypertension and chronic glomerulonephrotis. Duration of dialysis was from 03 to 49 months with mean of 19.64 +/- 11.7 months. Severity of depression was categorized in to mild, moderate and severe on the basis of BDI score. Majority of the patients fifty [56.1%] were moderately to severely depressed and there was no gender difference in the prevalence of depression. Majority of patients undergoing hemodialysis were depressed. Major risk factors for depression were marital status, illiteracy, number of children, socioeconomic factors, gender, hypertension and hypoalbuminemia. Patients with anemia, hyponatremia and hyperkalemia had suicidal tendency. Patients with hepatitis C and disturbed liver function have strong correlation with psychological parameters