The implication of aortic calcification on severe erectile dysfunction in patients with end stage renal disease
Fujita, N1; Hatakeyama, S1; Yamamoto, H1; Imai, A1; Yoneyama, T1; Hashimoto, Y1; Koie, T1; Ohyama, C1
1: Hirosaki University Graduate School of Medicine, Japan
Objective: Erectile dysfunction (ED) has great impact of Quality of Life in patients with end stage renal disease (ESRD). It is estimated to occur at a rate of about 60%. Previous studies had identified potential risk factors of ED in patients with ESRD, including age, hemodialysis vintage and plasma testosterone concentration. Because ED is associated with vascular degradation, we hypothesized that preexisting aortic calcification may play a crucial role in severity of ED. The aim of the present study was to investigate the implication of aortic calcification on severe ED in patients with ESRD.
Material and Method: We treated 85 male patients with ESRD in our hospital. Of those, we included 57 patients with the age less than 75 years old. We evaluated sexual function using Sexual Health Inventory for Men (SHIM). Patients were divided into two groups between mild/moderate (total SHIM scores ≥8) and severe (total SHIM scores ≤7) ED groups. An aortic calcification was evaluated using aortic calcification index (ACI, %). The optimal cutoff value of the intensity of ACI for severe ED status was calculated with the ROC curve. Multivariate logistic regression analysis was performed to identify significant factors for influencing on severe ED.
Results: Median age was 61 years old in this cohort. Although plasma testosterone concentration was normal in most patients (54/57, 95%), ED was inherent in all patients. Thirty-six patients (63%) were diagnosed as a severe ED. The optimal cutoff value of the intensity of ACI for severe ED status was 80% (AUC = 0.811, P = 0.001), and rate of severe ED status was significantly higher in patient with ACI >80% (100%) than ACI <80% (44.7%) (P < 0.0001). In univariate analysis, age and ACI were selected as significant risk factors for severe ED. In multivariate analysis, ACI was selected as a significant independent risk factor for severe ED in patients with ESRD.
Conclusions: Prevalence of ED was higher than we expected in Japanese patients with ESRD. ACI was significantly associated with ED status. Aortic calcification may be one of the surrogate markers for penile vascular degradation in ESRD patients.
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