Sexual dysfunction in kidney disease patients requires study

Despite the very high rate of problems with sexual function among people with chronic kidney disease (CKD), little is known about the best treatment approaches in this group of patients, according to a study appearing in an upcoming issue of the Clinical Journal of the American Society Nephrology (CJASN).

"Sexual dysfunction is an important but underrecognized problem in people with chronic kidney disease," comments Giovanni F.M. Strippoli, MD, PhD, MPH, MM (Scientific Director of DIAVERUM and the Renal Research Coordinator at Mario Negri Sud Consortium, Italy). "We were surprised to find that the treatment options for sexual dysfunction in patients with kidney disease have not been fully studied, as this is a very common problem in CKD."

In a comprehensive search of the medical literature, the authors found 14 studies of existing treatments for sexual dysfunction in patients with CKD, including just 328 patients. Studies found that drug treatment was helpful for male CKD patients with erectile dysfunction, but there were few studies on safety and side effects in CKD patients. Very few studies evaluated treatments for sexual dysfunction in women with CKD.

Other treatment options—including mechanical devices or behavioral therapy—received little or no research attention.

The researchers were surprised by the lack of previous studies—especially since effective treatments are available and have been highly studied in the general population. "It's also very surprising considering the important focus on improving quality of life in patients with kidney disease, which is being more strongly recognized recently," Strippoli points out.

Strippoli and co-authors hope their research will address an unmet need in the CKD population and prompt further investigation into the diagnosis and treatment of sexual dysfunction in patients with CKD. "We have chosen a patient-focused research agenda.

Patients want research and subsequent solutions to help them cope with the quality-of-life problems accompanying kidney disease, including sexual dysfunction," says Strippoli. "Money and research efforts are needed to identify optimal treatments for sexual dysfunction in people with CKD."

The authors note that the few previous studies identified by their review were small, of short duration, and had other important limitations. Most of the studies evaluated drug treatments while other options were not investigated.

The authors reported no financial disclosures.

Study co-authors Mariacristina Vecchio, Giuseppe Lucisano, Giusi Graziano, Valeria Saglimbene, Marinella Ruospo, Carmen Bonifati (Mario Negri Sud Consortium), Sankar D. Navaneethan (Cleveland Clinic), David W Johnson (University of Queensland at Princess Alexandra Hospital, Brisbane, Australia), Marialuisa Querques (University of Milan), and Emmanuele A. Jannini (University of Chieti).The article, entitled "Treatment Options for Sexual Dysfunction in Patients with Chronic Kidney Disease: A Systematic Review of Randomized Controlled Trials,” will appear online at http://cjasn.asnjournals.org on May 13, 2010, doi 10.2215/CJN.09081209.