ERYTHROPOIETIN AND SEXUAL DYSFUNCTION

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 correct ion of anaemia. Nevertheless many male dialysis patients receiving rHu Epo continue to complain of sexual dysfunction. Methods. At a dedicate d renal impotence clinic, 65 male dialysis patients were screened for endocrine disturbances. Baseline serum sex hormones were compared betw een those receiving and not receiving rHuEpo, using either the two-sam ple t lest or the Mann-Whitney U test, after assessing for normality. Results from four patients were excluded on account of either medicati ons (antiemetic phenothiazines), hepatic dysfunction, or carcinomatosi s. Results. Twenty-five patients (41.0%) were receiving rHuEpo, the re cipients 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 mu mol/l, P<0.02), but similar nutritional status to the n on-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 nonrecipients (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 oe stradiol (304 Its 248 pmol/l, P = 0.095) in the rHuEpo-treated group. Forty-eight subjects (78.7%) received peritoneal dialysis (PD), with t he 19 rHuEpo recipients (39.6%) demonstrating increased serum testoste rone (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 haemo dialysis (HD) subjects. Conclusions. Male dialysis patients complainin g of sexual dysfunction after correction of anaemia with rHuEpo are ch aracterized by higher levels of serum testosterone and SHBG, but not s uppression of hyperprolactinaemia or hyperoestrogenism. Male PD subjec ts receiving rHuEpo also demonstrated increased LH and FSH.