Nephrology Dialysis Transplantation, Vol 12, Issue 4 741-747, Copyright © 1997 by Oxford University Press
IG Lawrence, DE Price, TA Howlett, KP Harris, J Feehally and J Walls
BACKGROUND: Erythropoietin (rHuEpo) therapy has been shown to improve
sexual function in the male dialysis population, with several studies
suggesting a direct effect upon endocrine function, as well as correction
of anaemia. Nevertheless many male dialysis patients receiving rHuEpo
continue to complain of sexual dysfunction. METHODS: At a dedicated renal
impotence clinic, 65 male dialysis patients were screened for endocrine
disturbances. Baseline serum sex hormones were compared between those
receiving and not receiving rHuEpo, using either the two-sample t test or
the Mann-Whitney U test, after assessing for normality. Results from four
patients were excluded on account of either medications (antiemetic
phenothiazines), hepatic dysfunction, or carcinomatosis. RESULTS:
Twenty-five patients (41.0%) were receiving rHuEpo, the recipients and
non-recipients being well matched for haemoglobin (10.19 +/- 0.29 vs 10.55
+/- 0.25 g/dl, n.s.), age (51.1 +/- 1.9 vs 53.6 +/- 2.1 years, n.s.) and
duration of sexual dysfunction (median, 3.0 vs 3.0 years, n.s.). The rHuEpo
recipients had a higher median creatinine (1090 vs 972 micromol/l, P <
0.02), but similar nutritional status to the non-recipients (albumin 41.0
vs 39.0 g/l, n.s.). The total duration of rHuEpo therapy was 0.85 +/- 0.14
years. Prolactin levels were similar in both the rHuEpo recipients and non-
recipients (440 vs 541 mu/l, n.s.), as were LH (11.0 vs 10.5 iu/l, n.s.)
and FSH (8.0 vs 6.5 iu/l, n.s.). However, there were significant elevations
of testosterone (19.8 +/- 1.3 vs 16.1 +/- 1.1 nmol/l, P < 0.05) and sex
hormone binding globulin (SHBG) (40.5 vs 26.0 nmol/l, P < 0.01), with a
trend toward elevated oestradiol (304 vs 248 pmol/l, P = 0.095) in the
rHuEpo-treated group. Forty-eight subjects (78.7%) received peritoneal
dialysis (PD), with the 19 rHuEpo recipients (39.6%) demonstrating
increased serum testosterone (21.0 +/- 1.5 vs 16.6 +/- 1.3 nmol/l, P <
0.05), SHBG (40.5 vs 26.5 nmol/l, P < 0.01), LH (15.0 vs 10.0 iu/l, P
< 0.01) and FSH (12.0 vs 5.3 iu/l, P < 0.05). These differences were
not demonstrated in the 13 haemodialysis (HD) subjects. CONCLUSIONS: Male
dialysis patients complaining of sexual dysfunction after correction of
anaemia with rHuEpo are characterized by higher levels of serum
testosterone and SHBG, but not suppression of hyperprolactinaemia or
hyperoestrogenism. Male PD subjects receiving rHuEpo also demonstrated
increased LH and FSH.
ORIGINAL ARTICLES
Erythropoietin and sexual dysfunction
Department of Diabetes and Endocrinology, Leicester Royal Infirmary, UK.
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