Impotence in kidney disease

Dialysis USA 3-2007 004 (Photo credit: jimforest)

Approximately 50% of uremic men complain of impotence or erectile dysfunction. An even larger proportion of patients also complain of decreased desire for sex as a result of kidney disease, this is particularly so among patients in stage 5 chronic kidney disease on dialysis.

The reason for this high incidence is related to the associated diseases that are frequently present in patients on dialysis as well as the physiologic alterations that occur because of chronic kidney disease on a vascular and hormonal level. Diabetes mellitus and hypertension are the two most common predisposing causes for chronic kidney disease. Both disease conditions are associated with dysfunction of the blood vessels with an impairment of the ability to relax when needed. This affects the blood vessels within the penis as well resulting in decreased blood flow in this organ due to impaired relaxation in response to appropriate sexual stimulus.

Chronic kidney disease results in several co-morbidities, in my opinion the two most important of these are cardiovascular disease and anemia. They are both related to CKD as well as to each other. The presence of cardiovascular disease in CKD is due in part to the extreme inflammatory state that occurs in patients with kidney disease as well as due to in the increased workload carried by the heart due to retention of fluid in the presence of a decreased supply of oxygenated blood due to anemia. Anemia on the other hand is due to decreased production of erythropoietin by the kidney. This hormone is essential for the the stimulation of bone marrow to produce red blood cells which are the primary constituent of blood.

The desire for sex in men on hemodialysis increases when anemia is treated, this is caused by increased energy levels and individuals perceive themselves as being more vital and they feel "less sick" when the blood count is elevated to about 10 mg/dl by treatment with drugs such as Epogen or CERA. It has been shown in some studies that testosterone levels may also be linked to the treatment of anemia in CKD with increased levels correlating with higher blood counts.

The evaluation of this complex disorder must also include psychological testing. However the efficacy of psychotherapy which essentially is talking about the problem and working through any issues which may be preventing performance is unknown. The use of antidepressant medication for this indication in dialysis patients is not well studied and there are significant possibilities of negative drug to drug interactions along with nebulous required dose adjustments due to renal failure and dialysis to complicate matters. The use of various other methods such as direct injection of the penis with drugs to increase blood flow to the area or surgical prosthesis is certainly possible but may not be socially acceptable as many men find injection of the penis or any surgery in that area distasteful.

The real success story of the treatment of erectile dysfunction in patients with chronic kidney disease is Viagra. Sildenafil the active ingredient in viagra increases nitric oxide levels which result in powerful vasodilation. The drug specifically targets nitric oxide production in penile blood vessels thus preventing systemic vasodilation and resulting severe hypotension (low blood pressure).

Since one of the primary causes of erectile dysfunction in chronic kidney disease is decreased relaxation this treats the cause directly in the majority of patients with good effect.



photo credit: Felixe

So an approach centered around ensuring the patient is well enough for sex, treating anemia hence improving libido, adequate dialysis if on dialysis with counselling aimed at identifying and removing psychological factors which may impair performance. And if necessary prescription of Viagra or Equivalent sildenafil like compound, will be likely to produce very good results.

Diabetes Symptoms! act early to Prevent Kidney Disease

Diabetes symptoms are more serious than you think!

It's important for you to know the symptoms as a first line indication as to whether you or your children have contracted it? If you are aware that you have any of these symptoms then you need to take action right away. Diabetes is a highly debilitating illness which often ends in death and it needs to be taken seriously.

Overview of the most significant possible symptoms of diabetes. See Wikipedia:Diabetes#Signs_and_symptoms for references. Model: Mikael Häggström. To discuss image, please see Template talk:Häggström diagrams (Photo credit: Wikipedia)

Alkaline water has been discovered to be very effective in alleviating the symptoms of diabetes and assisting sufferers get off their prescriptions... but before you do anything else,it is very critical to seek professional medical consultation first and foremost.

In Type 1 diabetes, the symptoms can often come on suddenly and dramatically. It mostly shows up in childhood or early teens often after an illness, virus or injury. The extra stress can cause diabetic ketoacidosis. Without treatment, ketoacidosis can lead to coma and death.

Symptoms of Type 2 diabetes are often not obvious and you may think they are due to aging or obesity. It's possible to have Diabetes 2 for many years without being aware that you have it. Steroids and stress can be big factors in the onset of Diabetes 2. It's important to take this illness seriously; it can lead to unpleasant outcomes like blindness, kidney failure, heart disease, and nerve damage.

Here are some common symptoms of diabetes 1 and diabetes 2

Excessive and Unusual Tiredness:

When you contract diabetes the body is mostly unable to use glucose for fuel. It begins instead to metabolize fat to get the extra fuel it needs. This process is not very efficient. You have less energy than before and you feel tired.

Weight Loss You Just Can't Explain:

Because you can't metabolize sugar, much of the fuel in your food is excreted in your urine via the kidneys. You may find yourself eating way more food than normal and still losing weight. You become dehydrated and lose even more weight.

Excessive thirst:

The high concentration of sugar in your bloodstream overcomes your normal kidney function. Instead of being re-absorbed for future use the sugar is passed out in your urine. The brain senses a need to dilute the blood and you experience this as thirst. As a result you find yourself drinking more water as the body tries to correct this sugar imbalance.

Increased Urination:

The body tries to excrete the excess sugar via the kidneys. As a result you pass more water and feel thirsty.

Overeating:

The body will try to increase its levels of insulin production to reduce the excess blood sugar. Insulin is the key that opens the muscles and lean tissue to receive the sugar. But in Type 2 Diabetes you become insulin resistant. Your muscles refuse to take up the sugar.

One of the other jobs of insulin is to make you hungry... it isn't possible for you to absorb this extra insulin so your forced to eat more.

Wounds Refuse to Heal:

If your blood sugar levels are high then your white blood cells are not able to do their respected job. As a result to this your wounds heal slower than normal and your more susceptible to infection.

Thickening of the Arteries

SEELOW, BRANDENBURG - AUGUST 08: Country doctor Dieter Baermann measures the blood sugar level of an elderly patient in the patient's home on August 8, 2011 in Sachsendorf near Seelow, Germany. Baermann works in the state of Brandenburg in eastern Germany, a region that is struggling with a shortage of doctors in rural areas. Critics charge that current laws actually discourage doctors from taking up posts in rural areas, and the German government is debating a new law intended to reverse the trend. Many doctors across Germany complain about a legal system that they claim burdens them with too many costs and hampers their ability to provide the best care. (Image credit: Getty Images via @daylife)

Long term diabetes can cause your arteries to thicken, reducing blood flow.

You catch more Infections:

Because your immune system is no longer functioning as well as it should you'll often find you are contracting skin and yeast infections as well as urinary tract infections.

Mood Swings:

You may very well find yourself incapable of concentrating, irritated, or agitated- all are symptoms of very high blood sugar levels

Impaired Vision: You may find you have difficulty focusing and things appear blurry.

Don`t give up! There are herbal methods available .

Education: High Blood Pressure Prevention.

Main complications of persistent high blood pressure. Sources are found in main article: Wikipedia:Hypertension#Complications. To discuss image, please see Template_talk:Häggström diagrams. To edit, please use the svg version, convert to png and update both versions online. (Photo credit: Wikipedia)

Most of people with hypertension do not know they have it. In fact it has been estimated that about 50 percent are not aware of it. It is estimated by the year of 2025, one and half billion of people will live with High Blood Pressure.

High blood pressure can be caused by a malfunctioning kidney and adrenal gland dysfunction; yet, about ninety to ninety five percent of all cases have an unknown nature.

Even though, medicine is still searching for the right answers for cure of the silent disease, it is up to the patients to find remedies and cures to keep up their health. There are several ways to reduce your blood pressure. This article will focus on how to lower your blood pressure by losing weight.

Losing weight can be very challenging because it involves change in the lifestyle. However, once the individual is able to make few changes in the lifestyle losing weight becomes automatic.

Based on review from to British Hypertension Society, low intensity aerobic exercise can aid in lowering your blood pressure drastically. A low intensity aerobic exercise can be 20-30 min walk to a park or grocery store, slow movement yoga class, cardio workout class. It is important to maintain the routine and to exercise minimum three times a week.

The results do not show for the first 2 weeks. However, drastic results can be seen after one month. Losing weight happens in stages and an individual should be patient with him/herself. Even if the person will not see instant results in weight loss, the hypertension will be treated from the first day of exercise. Even low intensity activity will increase blood flow and improve cardiovascular system by flushing the bad cholesterol out of the body.

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Find more Ways to treat High Blood Pressure

Eating the right type of foods is just as essential as the exercising. It is critical to eat everything in moderation and to avoid cravings. Many fitness instructors recommend taking small meals up to 6 times a day. When picking groceries chose chicken breast over a thigh or drumstick, very soon it will becomes natural picking the foods that are lower in cholesterol and a lot healthier for the body.

Consuming high amounts of water stimulates detoxification of body and helps healing processes to take place faster. By avoiding pops, fast food, processed foods one can eliminate about 30% of empty calorie intake.

While there is no precise explanation on the onset of hypertension, there are ways available to control and to prevent this disease. Maintaining a healthy weight by exercising and eating the right foods is one of many ways to battle high blood pressure.

While there is no perfet explanation to Hypertension, there are natural ways available to control and prevent this disease. Keeping a healthy weight by exercising and eating right is one of many ways to combat hypertension.

Dialysis and Death the Double D's and DOPPS.

dialysis - session 4 (Photo credit: wj gibson (Archie Goodwin))

Hemodialysis is a life saving therapy for patients with severe kidney disease. The therapy is well established and is the most readily available form of renal replacement therapy in the United States. Improving survival on dialysis is the aim of several ongoing studies. The largest of these studies is the Dialysis Outcomes and Practice Patterns study or (DOPPS). The investigators sought to determine detailed information about the association of various co-morbid and clinical characteristics of patients which may shed light on the causes of death and ultimately how to increase length and quality of life on dialysis.

Data from the DOPPS study suggests that patients are at the highest risk of death within 120 days after starting dialysis. This increased risk of death is believed to be based on patient specific factors such as age, race and the presence of various co-morbidities. Previous studies that have attempted to isolate the predictors of early death in patients starting dialysis have revealed death rates as high as 12% for the first 90 days.

The DOPPS study has revealed that death within 120 days was more likely in patients that were.

• Elderly


• White


• Diagnosed with heart failure.


• Utilized a catheter for first dialysis.


• Diagnosed with cancer


• Diagnosed with lung disease


• Diagnosed with neurologic disease


• Diagnosed with psychiatric disorder


• Were referred late to a specialist.



Simplified hemodialysis circuit. (Photo credit: Wikipedia)

Although some of these risk factors are admittedly unchangeable and expected. Two risk factors are particularly note worthy. Late referrals and the use of a catheter at first dialysis session. These two factors are a more direct index of the degree of health care that the patients received during their follow up prior to needing dialysis. Any death due to these two factors within the first 120 days of starting dialysis are directly preventable by simply following the established protocols. Patients should be referred to a specialist in a timely manner such that interventions are possibly that will improve the prognosis of the patient.

Catheters are a form of dialysis access that are grossly inferior to other methods of accessing the blood stream for the purposes of dialysis. The use of catheters at first dialysis are associated with increased risk of life threatening infection and decreased dialysis adequacy and thus decreased survival and quality of life. The choice to place a catheter as a form of first access should only be made when no other access is possible. However discussing the types of possible access and the pros and cons in a manner that allows the patient an educated choice will take time hence the need for early referral.

Late referral to a nephrologist almost always results in the use of a catheter. The quality of life of patients may therefore be significantly improved by referring patients to a nephrologist in a timely manner to allow for a more appropriate choice of access such as a natural AV fistula.

In summary while some factors are unmodifiable such as age and race, we must strive to maximize the benefit of other factors that are well within our ability to modify by simply improving basic patient care in the pre dialysis period.

Related articles

• Most women on dialysis may experience sexual problems (medicalxpress.com)
• New Dialysis Catheter Reduces Thrombus Accumulation (prweb.com)
• Muscle Cramps In Dialysis Treated By Vitamin E (allkidney.com)
• Cannulation Technique may Improve Fistula Survival (allkidney.com)
• Older Dialysis Patients May Not Derive Benefit from Dialysis (allkidney.com)