• Humans
• Male
• Kidney Transplantation
• Erectile Dysfunction/etiology
• Erectile Dysfunction/blood
• Middle Aged
• Kidney Failure, Chronic/complications
• Kidney Failure, Chronic/therapy
• Kidney Failure, Chronic/blood
• Adult
• Gonadal Steroid Hormones/blood
• Cohort Studies
• Testosterone/blood
• Renal Dialysis
• Prolactin/blood
• Peritoneal Dialysis
• Luteinizing Hormone/blood
• Aged

• anti‐osteoporotic agents
• chronic kidney disease‐mineral and bone disorder (CKD‐MBD)
• hormonal abnormalities
• management of electrolytic abnormalities
• renal osteodystrophy
• vitamin D administration

• Humans
• Chronic Kidney Disease-Mineral and Bone Disorder/therapy
• Chronic Kidney Disease-Mineral and Bone Disorder/etiology
• Renal Insufficiency, Chronic/complications
• Renal Insufficiency, Chronic/therapy
• Quality of Life

• chronic kidney disease
• reproduction
• sexual activity
• sexual function
• sexual health
• sexual satisfaction
• women’s health

• adolescent
• chronic illness
• contraception
• sexual health
• young adult

• the Health Resources and Services Administration (HRSA)

• Gonadal steroid hormones
• Kidney transplantation
• Muscle
• Skeletal
• Transgender persons

• Adult
• Female
• Humans
• Male
• Gender Identity
• Kidney Transplantation
• Sex Reassignment Procedures
• Sex Reassignment Surgery
• Transgender Persons

• di-(2-ethylhexyl) phthalate
• inducible degrader of the low-density lipoprotein receptor
• liver X receptor α
• low-density lipoprotein receptor
• peroxisome proliferator-activated receptor γ
• proprotein convertase subtilisin/kexin type 9
• reactive oxygen species
• statin
• transient receptor potential ankyrin 1

• COVID-19
• Coronavirus
• SARS-CoV-2
• endothelial dysfunction
• erectile dysfunction
• testosterone

• COVID-19/complications
• Cardiovascular Diseases/etiology
• Erectile Dysfunction/epidemiology
• Humans
• Male
• Penile Erection
• Testosterone

• Sexual dysfunction
• chronic kidney disease
• erectile dysfunction
• phosphodiesterase type 5 inhibitor
• testosterone

Sexual dysfunction is defined as any abnormality in sexual arousal, libido, intercourse, orgasm, or satisfaction. It is prevalent in patients with chronic and end-stage kidney disease, with 70% to 84% of men and 30% to 60% of women reporting some form of sexual dysfunction. Although kidney transplantation improves the overall quality of life for patients receiving dialysis, it can have unexpected effects on sexual function owing to the use of immunosuppressive medications and comorbid illnesses. It is important to recognize these adverse effects and pre-emptively discuss them with patients to help mitigate consequent psychosocial discontent. Women of reproductive age will often recover fertility after kidney transplantation and therefore need to be empowered to prevent unwanted pregnancies and plan for a safe pregnancy if desired. Complications such as preeclampsia, pregnancy-induced hypertension, gestational diabetes, ectopic pregnancy, still birth, low birth weight, and preterm birth are more common in pregnant women with a kidney transplant. Careful monitoring for infection, rejection, and immunosuppressive dose adjustment along with comanagement by a high-risk obstetrician is of utmost importance. Breast-feeding is safe with most immunosuppressive medications and should be encouraged.

• Pregnancy
• contraception
• kidney transplant
• sexuality

Depression and anxiety are the most common psychiatric disorders in end-stage renal disease (ESRD) patients treated with hemodialysis (HD) and may correlate with lower quality of life and increased mortality. Depression treatment in HD patients is still a challenge both for nephrologists and psychiatrists. The possible treatment of depressive disorders can be pharmacological and non-pharmacological. In our article, we focus on the use of sertraline, the medication which seems to be relatively safe and efficient in the abovementioned population, taking under consideration several limitations regarding the use of other selective serotonin reuptake inhibitors (SSRIs). In our paper, we discuss different aspects of sertraline use, taking into consideration possible benefits and side effects of drug administration like impact on QTc (corrected QT interval) prolongation, intradialytic hypotension (IDH), chronic kidney disease-associated pruritus (CKD-aP), bleeding, sexual functions, inflammation, or fracture risk. Before administering the medication, one should consider benefits and possible side effects, which are particularly significant in the treatment of ESRD patients; this could help to optimize clinical outcomes. Sertraline seems to be safe in the HD population when provided in proper doses. However, we still need more studies in this field since the ones performed so far were usually based on small samples and lacked placebo control.

• depression
• hemodialysis
• sertraline

Although renal-transplant-recipients can lead much more comfortable life in comparison to patients on dialysis, they need to face other problems. One of them is lifetime immunosuppressive therapy on daily basis. Immunosuppressive regimen contains usually three different drugs and although each one of them is crucial to keep graft in good condition and to suppress immune response against the transplanted organ, they influence, among the other, reproductive system. In current paper we have observed that immunosuppressive therapy based on tacrolimus significantly affected the hormonal balance of sex hormones in both men and women. It is of great importance, as nowadays infertility is rising problem even in health people, therefore more attention should be paid to choose the best suitable immunosuppressive regiment for recipient in reproductive age.

It is estimated that approximately 20% of couples suffer from infertility worldwide and within renal-transplant recipients, this problem is 10 times more common. An intake of immunosuppressants may lead to hormonal imbalance. The aim of the study was to investigate the influence of tacrolimus-based therapy on the hormonal status of grafted patients. Blood samples were obtained from patients from the Department of Nephrology, Transplantology, and Internal Medicine of Independent Public Clinical Hospital No. 2, Pomeranian Medical University. All 121 patients had stable graft function for over 6 months. The blood plasma concentrations of luteinizing hormone, follicle-stimulating hormone, prolactin, testosterone, estradiol, cortisol were assessed by the electrochemiluminescence method. We observed decreased levels of prolactin (11.9 ng/mL) and cortisol (87.4 μg/mL) in patients under tacrolimus-based therapy. Tacrolimus-based therapy was also associated with increased testosterone and follicle-stimulating hormone in males, 4.04 ng/mL and 6.9 mLU/mL, respectively, and decreased testosterone levels in females, 0.121 ng/mL. We also assessed that immunosuppressive therapy based on tacrolimus is less nephrotoxic in comparison to other regimens. Concluding, tacrolimus-based therapy may influence the hormonal status of transplant recipients in the current study. Results presented here are believed to be helpful for clinicians and patients, especially within the aspect of willingness for biological offspring.

• hormones
• immunosuppressants
• renal transplantation

Nowadays, the average human life expectancy is increasing. This applies to both healthy and chronically ill people. It is possible due to improvements in technology, living conditions, and better, more accessible medical care. As the number of patients with end-stage organ failure increases and due to great progress in modern transplantology, every year the number of transplantations rises worldwide. Organ transplantation is not only an ultimate form of therapy but also, especially nowadays, a life-saving procedure. Patients who have undergone transplantation need to face the problem of long-term immunosuppressive therapy on a daily basis, which prolongs the proper function of the grafted organ and prevents the development of graft-versus-host disease. On the other hand, numerous side effects are associated with the usage of these medicaments, among these are disturbances in sex-related hormones, therefore influencing fertility.

The rising need for treatment of end stage of organ failure results in an increased number of graft recipients yearly. The most commonly transplanted organs are kidney, heart, liver, bone marrow, lung and skin. The procedure of transplantation saves and prolongs the lives of chronically ill patients or at least improves the quality. However, following transplantation recipients must take immunosuppressive drugs on a daily basis. Usually, the immunosuppressive therapy comprises two or three drugs from different groups, as the mechanism of their action varies. Although the benefits of intake of immunosuppressants is undeniable, numerous side effects are associated with them. To different extents, they are neurotoxic, nephrotoxic and may influence the function of the reproductive system. Nowadays, when infertility is an urgent problem even among healthy pairs, transplant recipients face the problem of disturbance in the hypothalamic−pituitary axis. This review will provide an overview of the most common disturbances among the concentration of sex-related hormones in recipients of both sexes at different ages, including sexually immature children, adults of reproductive age as well as elderly women and men. We have also focused on the numerous side effects of immunosuppressive therapy regarding function and morphology of reproductive organs both in males and females. The current review also presents the regimen of immunosuppressive therapy and time since transplantation.

• Chronic kidney disease
• endocrine disorders
• metabolic disorders
• nutrition

• Estrogen
• chronic kidney disease
• dialysis
• end-stage renal disease
• fertility
• menopause

• Amenorrhea/etiology
• Estrogens
• Female
• Humans
• Kidney Failure, Chronic
• Renal Insufficiency, Chronic/complications
• Uremia

Around 20% to 30% of patients after solid organ transplantation are of reproductive age. The estimated rate of infertility in this group is slightly higher than in the general population. Choosing the optimal moment for pregnancy in transplanted patients plays a pivotal role, regardless of the method of conception. The first part of this article presents an up-to-date review of the problem of infertility in female and male solid organ recipients, with special attention to the influence of specific immunosuppressive drugs on semen parameters. The second part discusses the current knowledge regarding infertility treatment and the results of assisted reproductive techniques in this specific group of patients.

Despite restoring gonadal functions after transplantation, the patients should be informed about possible negative effects of medications on fertility, course of pregnancy, and the fetus. Interdisciplinary care should always be provided for infertile graft recipients, especially women, as it ensures safety both for the graft and for the potential gestation. The process of infertility diagnosis and tools used for that purpose are the same in transplanted patients as in the general population. The treatment with assisted reproductive techniques is acceptable and gives favorable results as long as patients are managed rationally, with special attention paid to prevention of iatrogenic complications.

• Female
• Humans
• Kidney/physiopathology
• Kidney Diseases/complications
• Kidney Diseases/physiopathology
• Kidney Diseases/therapy
• Kidney Transplantation/adverse effects
• Kidney Transplantation/methods
• Patient Care Management/methods
• Patient Care Management/trends
• Pregnancy
• Pregnancy Complications/etiology
• Pregnancy Complications/physiopathology
• Pregnancy Complications/therapy
• Pregnancy Outcome
• Pregnancy, High-Risk
• Reproductive Health
• Risk Adjustment
• Sexual Dysfunction, Physiological/etiology
• Sexual Dysfunction, Physiological/physiopathology
• Women's Health

• adolescents
• contraception
• sexual behavior
• solid organ transplantation

• Chronic kidney disease
• Dialysis
• End-stage kidney disease
• Sexual dysfunction
• Women

Sexual dysfunction occurs commonly in people with chronic kidney disease (CKD) and has been recognized as a research priority. We sought to evaluate the current state of the literature addressing sexual dysfunction in people with CKD and identify barriers and strategies to improve our management of this important symptom.

OVID Medline and Google Scholar were searched for English, peer-reviewed studies using keywords and terms related to “Chronic Kidney Disease,” “sexuality,” and “sexual dysfunction OR function.”

In this narrative review, we describe definitions of sexual dysfunction and contributors exacerbated by CKD, barriers to researching sexual dysfunction in people with CKD, and possible avenues for future research.

Sexual dysfunction is common in people with CKD and results from a combination of kidney disease itself, as well as its associated physical (ie, comorbidities) and nonphysical factors. Barriers to the study of sexual dysfunction in CKD include inconsistent disease definitions, stigma, variable efficacy and safety of established therapies, and evolving gender roles in sexual function. Potential avenues for future research to improve the sexual function in people with CKD may include evaluating the safety and efficacy of established therapies in people with CKD using a variety of observational and interventional study designs, engaging people with CKD and multidisciplinary team members in research, and using implementation science methods to translate what is known about sexual function into clinical practice. Concerted efforts are required to break down barriers and improve sexual function in people with CKD. Patients have identified this as an important research priority, and national networks need to direct efforts to reduce symptom burden.

This narrative review was limited by a paucity of high-quality studies examining sexual dysfunction specifically in people with kidney disease.

• chronic kidney disease
• narrative review
• sexual function
• sexual health

• Adolescent
• Chronic kidney disease
• Hyperprolactinemia
• Menstrual disorder

• Adult
• Diabetes Mellitus, Type 1/complications
• Diabetes Mellitus, Type 1/psychology
• Female
• Health Status
• Humans
• Middle Aged
• Severity of Illness Index
• Sexual Behavior/psychology
• Sexual Dysfunction, Physiological/etiology
• Sexual Dysfunction, Physiological/psychology
• Sexual Dysfunctions, Psychological/etiology
• Sexual Dysfunctions, Psychological/psychology
• Young Adult

• Antimüllerian hormone
• Antral follicle count
• Chronic kidney disease

• chronic non-cancer pain
• opioids
• patient's reports of adverse events
• pharmacovigilance data recording system
• suspected adverse drug reaction

• Organ transplantation
• Sexual activity
• Sexual initiation

• Adolescent
• Adult
• Coitus
• Contraception Behavior
• Cross-Sectional Studies
• Female
• Health Knowledge, Attitudes, Practice
• Humans
• Marital Status
• Middle Aged
• Organ Transplantation/statistics & numerical data
• Poland
• Postoperative Period
• Preoperative Period
• Sexual Partners
• Surveys and Questionnaires
• Young Adult

• chronic kidney disease
• hypogonadism
• prolactin
• sexual function
• testosterone

• OPIAD
• Salivary testosterone
• chronic pain
• erectile dysfunction
• opioids
• sexual dysfunction

• Aged
• Analgesics, Opioid/administration & dosage
• Analgesics, Opioid/adverse effects
• Androgens/deficiency
• Case-Control Studies
• Chronic Pain/drug therapy
• Cross-Sectional Studies
• Erectile Dysfunction/chemically induced
• Humans
• Male
• Middle Aged
• Pain Measurement
• Saliva/chemistry
• Surveys and Questionnaires
• Testosterone/deficiency

Increased life expectancy and the growing phenomenon of aging can lead to increased burden of chronic diseases (CDs) which adversely affects the overall health of elderly, their sexuality in particular. Sexual life of an aged population is overlooked in many of the societies. In the present narrative review, we aim to assess the impact of CDs on sexual function of elderly people.

We used internet databases including PubMed, EMBASE, ISI Web of Science, Google Scholar, SID, Iran Medex, Magiran, IPPF, and UNFPA without time limit. Ninety-eight out of 174 relevant articles were selected which met the inclusion criteria: those articles were research-based in English or Persian (original or review articles) and textbooks; specified one or more CDs and sexual function of the cases; elderly people over the age of sixty, men and women; and coordination between articles and research goals. We excluded qualitative and case studies. We reported the most related CDs with sexual function in literature review and used the biological and psychological impact of the CDs on sexual function of elderly population based on the conceptual model of Verschuren et al. (2010).

The results of the studies were classified into the themes including physical, psychological, and cultural and social. Diabetes, cardiovascular, cancerous, and chronic respiratory diseases and also some medications can reduce sexual capacity and desire in particular resulting in negative impact on the quality of elderly sexual life. CDs may influence sexual expressions and responses which adversely affect one's mood and energy so that can cause depression and grief, as well as loss of self-confidence, self-esteem, and self-concept in elderly adults. The factors affecting sexuality of an elderly with CDs include cultural and mythical beliefs about age and illnesses, fear, and embarrass of changed physical appearance. The research conducted among elderly population examining the adverse influence of CDs on aged people's sexual life in general, sexual function and performance, and intimate interaction.

It is considered that programs on sexual health needs of aged population for the health-care workers can prove beneficial in improving sexual health.

• Aging
• chronic diseases
• review
• sexuality

• Infertility
• Peritransplant counseling
• Renal transplant recipients

Numerous spontaneous pregnancies have been reported in renal transplant recipients; however, only a few pregnancies after the use of assisted reproductive techniques. The authors report a case of renal transplant recipient with secondary infertility who delivered a healthy baby without any complications. The report highlights the importance of minimal stimulation protocol during ovarian stimulation, single embryo transfer, and the need for multispecialty care for these patients. To the best of the authors' knowledge, the present report is the first such case from India and also the second in the world to report a blastocyst transfer among renal transplant recipients.

• In vitro fertilization
• infertility
• renal transplant
• single embryo blastocyst transfer

Pregnancies in hemodialysis patients are uncommon and difficult to study. Although the chance of a successful pregnancy and parturition in hemodialysis women has increased over the years, it still remains extremely low with a high maternal and fetal mortality and morbidity rate.

We reported a case of successful pregnancy and parturition in a 22-year-old Chinese female in uremic stage of chronic renal failure and undergoing maintenance hemodialysis (three sessions a week) for 6 years. At the 22nd gestational week, she was diagnosed as pregnant by ultrasound, and started an enhanced hemodialysis routine (Five sessions a week). At the 32nd gestational week, she got hospitalized and received hemodialysis more frequently (seven sessions a week). Based on the initial diagnoses, including uremic stage of chronic renal failure, stage-3 hypertension, single pregnancy of 32nd gestational week, single umbilical artery and polyhydramnios, a drug therapy consisting of compound amino acid, fructosediphosphate sodium, 10 % L-carnitine, erythropoietin, polyferose, amlodipine, isosorbidedinitrate, low-molecular weight-heparin, multivitamins and folic acid was given, and daily examination of the mother and fetus was performed. Under the joint efforts of various departments, the patient underwent caesarean section at the 34th gestational week due to progressive uterine contraction and gave birth to a female, well-being baby weighing 1470 g. It has been more than 3 years since the parturition. The mother has returned to the previous hemodialysis routine, and the child has been growing up healthily.

Although pregnancy in hemodialysis patients is rare, with a high rate of risks. Patients could still gain a good outcome, if we intensify hemodialysis and enhance the collaboration between the patient, nephrologists, obstetricians, neonatologist, nutritionists, and other departments.

• kidney disease
• menopause
• vasomotor symptoms
• cardiovascular
• epidemiology

• Aged
• Cohort Studies
• Female
• Glomerular Filtration Rate
• Humans
• Menopause
• Middle Aged
• Proportional Hazards Models
• Renal Insufficiency, Chronic/epidemiology
• Renal Insufficiency, Chronic/mortality
• Renal Insufficiency, Chronic/physiopathology
• United States/epidemiology
• Women's Health

• HHSN268201100001I NHLBI NIH HHS
• HHSN268201100004I NHLBI NIH HHS
• HHSN268201100046C NHLBI NIH HHS
• T32 DK007357 NIDDK NIH HHS
• HHSN268201100002C WHI NIH HHS
• HHSN268201100003I NHLBI NIH HHS
• HHSN268201100002I NHLBI NIH HHS
• HHSN268201100004C WHI NIH HHS
• HHSN268201100003C WHI NIH HHS
• UL1 TR001409 NCATS NIH HHS
• K24 DK085446 NIDDK NIH HHS
• HHSN268201100001C WHI NIH HHS

Chronic kidney disease (CKD) is encountered in millions of people worldwide, with continuously rising incidence during the past decades, affecting their quality of life despite the increase of life expectancy in these patients. Disturbance of sexual function is common among men with CKD, as both conditions share common pathophysiological causes, such as vascular or hormonal abnormalities and are both affected by similar coexisting comorbid conditions such as cardiovascular disease, hypertension and diabetes mellitus. The estimated prevalence of erectile dysfunction reaches 70% in end stage renal disease patients. Nevertheless, sexual dysfunction remains under-recognized and under-treated in a high proportion of these patients, a fact which should raise awareness among clinicians. A multifactorial approach in management and treatment is undoubtedly required in order to improve patients’ quality of life and cardiovascular outcomes.

• Chronic kidney disease
• Erectile dysfunction
• Management
• Quality of life
• Hypertension
• Diabetes mellitus
• Phosphodiesterase-5 inhibitors

• ERK1/2
• cardiovascular disease
• chronic kidney disease
• estrogen receptor-α
• inflammation

• heart transplant
• pregnancy

• Adult
• Breast Feeding/methods
• Decision Making
• Directive Counseling
• Female
• Heart Transplantation
• Humans
• Immunosuppressive Agents/therapeutic use
• Infant
• Infant, Newborn
• Practice Guidelines as Topic
• Pregnancy
• Pregnancy Complications, Cardiovascular/immunology
• Pregnancy Complications, Cardiovascular/mortality
• Pregnancy Complications, Cardiovascular/therapy
• Pregnancy Complications, Infectious/immunology
• Pregnancy Complications, Infectious/mortality
• Pregnancy Complications, Infectious/therapy
• Pregnancy Outcome
• Pregnancy, High-Risk
• Prognosis
• Survivors

• T32 HL007854 NHLBI NIH HHS

• End-stage renal disease
• Female
• Gender difference
• Hemoglobin
• Testosterone

• Adult
• Aged
• Aged, 80 and over
• Female
• Hemoglobins/analysis
• Humans
• Kidney Failure, Chronic/blood
• Kidney Failure, Chronic/therapy
• Male
• Middle Aged
• Prospective Studies
• Renal Dialysis
• Sex Factors
• Testosterone/blood