Do sexual dysfunctions get better during dialysis? Results of a six-month prospective follow-up study from Turkey.

Dialysis improves most symptoms of end-stage renal disease (ESRD), yet many patients continue to experience sexual dysfunction (SD) during the dialysis treatment. The aim of this preliminary study was to evaluate the frequency and the course of SD during a 6-month dialysis treatment. Additionally, relationships between the level of depression, cognitive impairment and biochemical parameters of SD were also assessed. The subjects were 43 ESRD (25 male and 18 female) on dialysis treatment for at least 12 months. SD was assessed using the Arizona Sexual Experiences Scale (ASEX); the level of depression and cognitive impairment were assessed using the Hamilton Depression Rating Scale (HDRS) and Mini Mental Status Exam (MMSE). Several biochemical parameters were also assessed. All assessments were carried out at baseline and repeated at 6-month follow-up. Of 43 patients, 20 (47%) and 18 (42%) complained of SD at baseline and at 6-month assessments, respectively. Of 25 males, nine (36%) and seven (28%) patients described SD at baseline and 6-month assessments, respectively; erectile dysfunction was the most frequent complaint. Of 18 females, 11 (61%) and 11 (61%) patients reported SD at baseline and 6-month assessments, respectively; difficulties with arousal and reaching orgasm were the most frequent complaints. Both total and item-by-item comparisons of baseline and 6 months ASEX scores did not reveal any significant changes during 6-month period, indicating that patient's sexual functions do not improve with dialysis treatment. For female patients, HDRS scores were significantly higher in patients with SD at baseline (t = 2.15, P = 0.05) and at 6-month follow-up (t = 2.44, P = 0.03) assessments; after excluding the effects of age and duration of dialysis for females using regression analysis, HDRS still significantly (t = 4.02, P = 0.003) associated with the SD. This preliminary prospective study suggests that SD is frequent in dialysis patients, does not remit with dialysis treatment, associated with depression in female patients, and much clinical attention is indicated.

Sexual dysfunctions in HCV patients and its correlations with psychological and biological variables.

The frequency of sexual dysfunction (SD) is not very well known in patients with chronic hepatitis C. In this study, the prevalence of SD and its correlations with psychological and biological variables was assessed in 46 HCV positive patients. The mean age of patients was 46.4+/-9.4 y; the mean duration of HCV infection was 43.4+/-34.0 months; 52% were male; 89% were living with a spouse. SD was assessed using the Arizona Sexual Experiences Scale (ASEX), the level of anxiety and depression measured with the Hospital Anxiety and Depression Scale (HADS). Biochemical parameters were also assessed. Overall, as indicated by ASEX criteria, SD was observed in 35% of our patients. Of 24 males, 21% described SD; problems with drive (25%), arousal (17%) and erection (17%) were the most frequent complaints. Of 22 female patients, 50% described SD; problems with drive (55%) arousal (50%), and reaching orgasm (59%) were the most frequent complaints. Total ASEX scores were correlated with age (P<0.07, significant at trend level), education (P<0.001), and was higher in female patients (P<0.02). After controlling for the effects of age, sex, education, duration of HCV and marital status, depression levels could still significantly predict the SD (P<0.05). Moreover, even after controlling the effects of all other variables, gamma glutamyl transpeptidase (GGT) levels could predict the SD status of the patients (P<0.05). Our results indicate that the prevalence of SD was 35% in HCV-infected patients and the level of depression and GGT levels were predictive of patients SD status.

Cross-sectional assessment of psychiatric disorders in renal transplantation patients in Turkey: a preliminary study.

BACKGROUND: Psychiatric disorders such as depression and anxiety may be seen after a successful renal transplantation (RTx). The aim of this cross-sectional study was the assessment of psychiatric disorders after RTx in Turkey. The value of self-report scales in predicting depression and anxiety was also assessed. PATIENTS AND METHODS: The study group consisted of 20 male and 20 female RTx patients (mean age 35.42 +/- 10.09 years), with a mean duration of 61.65 +/- 48.30 months of follow-up after transplantation. All patients were assessed with the validated Turkish versions of Structured Clinical Interview for the DSM-IV (SCID-I), Beck Depression Inventory (BDI), Hospital Anxiety Depression Scales (HADS), Spielberger Trait Anxiety Inventory (STAI-I), and Beck Hopelessness Scale (BHS). RESULTS: Twenty of the 40 patients warranted a DSM-IV psychiatric diagnosis with SCID-I evaluation. Major depression was observed in 25% of patients. The remaining diagnoses were within the affective and/or anxiety spectrum disorders. The set of age, gender, education, income, marital status, employment, type of transplantation, duration of illness, and duration after the transplantation was not significantly different between patients with or without psychiatric diagnoses. BDI, HADS, STAI-I, and BHS were significantly higher among patients with psychiatric diagnoses at P = .001 level using Student t test. Even after control of the variance explained by the set of demographic variables, hierarchical regression analysis revealed that HADS scores significantly predicted the psychiatric morbidity (P = .003). CONCLUSION: The frequency of psychiatric disorders is quite high in renal transplantation patients. Additionally, HADS, which significantly predicts depression and anxiety, may be used for screening purposes.

The reliability and validity of Arizona sexual experiences scale in Turkish ESRD patients undergoing hemodialysis.

Although sexuality was the fifth most important life stressor cited by dialysis patients, sexual dysfunctions (SD) receive a very limited attention in the follow-up of these patients. The main aim of the present study was to investigate the reliability and validity of the Arizona Sexual Experiences Scale (ASEX) for end-stage renal disease (ESRD) patients undergoing hemodialysis (HD) in Turkey. The instrument's reliability and validity were assessed in 43 ESRD outpatients undergoing dialysis. All patients were assessed at baseline and at 6 months. ASEX showed good internal consistency (Cronbach's alpha's 0.89 and 0.90) and test-retest reliability (r=0.88, P<0.001). Convergent validity of ASEX was measured by means of the scales' correlation with the psychiatrists' assessment for the presence of SD (r=0.53, P<0.001). The results of receiver operating characteristics analysis for criterion validity revealed that ASEX scores could discriminate well (0.85+/-0.06 (95% confidence interval, 0.73-0.90), P<0.001) between patients with 'no SD (n=26)' and 'with SD (n=17)'. A total ASEX score of < or =11 was found to be the best cutoff point (sensitivity=100%, specificity=52%) for screening in this group of patients. The findings of this study indicate that the ASEX is a valid and reliable instrument for use in clinical trials on sexual functioning of ESRD patients undergoing HD.

Suicidal behavior, satisfaction with life, and perceived social support in end-stage renal disease.

BACKGROUND: Suicide has been rarely studied among end-stage renal disease (ESRD) patients. The purpose of this study is to assess the frequency of suicidal thoughts, plans, and attempts among ESRD patients including the interactions among suicidal behavior, the level of social support, and satisfaction with life. PATIENTS AND METHODS: The study group, of medically stable kidney recipients, including 20 men and 20 women had a mean 121.81 +/- 72.72-months follow-up for ESRD. All patients were administered a questionnaire including demographic and clinical characteristics; specific questions about psychiatry consultations, as well as questions about suicidal thoughts, plans, and attempts before and after transplantation. Patient responses were confirmed by chart reviews; inconsistencies were clarified with the patients. Additionally, all patients completed a validated Turkish version of two self-report scales, Satisfaction with Life Scale (SLS) and Multidimensional Scale of Perceived Social Support (MSPSS). RESULTS: In total, psychiatrists assessed 19 ESRD patients, including all suicidal patients. Eight patients reported "suicidal thoughts-plans," including two attempts. MSPSS results revealed that a history of psychiatric consultation (P <.05) and "suicidal thoughts-plans," (P <.05) significantly correlated with lower MSPSS scores. MSPSS scores were correlated with SLS (P <.05). Of all patients, six reported "suicidal thoughts-plans," including one suicide attempt prior to transplantation. Of six patients, one was married and five were not (P <.05). Among the three patients who reported suicidal thoughts-plans in the posttransplantation period, two, including one attempter, were new cases. CONCLUSIONS: High rates of suicidal thoughts-plans and attempts were found among our ESRD patients. The probability of suicidal behavior significantly increased among recipients that were single or divorced; whose satisfaction with life was decreased; and who perceived their family, friends, and significant others to be less supportive. More detailed prospective studies on suicide are needed for better care of ESRD patients.