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Research article

Chronic kidney disease report differently on change in sexual function dependent on treatment: a cohort study

  • † These two authors contributed equally.
  • Received: 19 January 2023 Revised: 17 May 2023 Accepted: 28 May 2023 Published: 09 June 2023
  • Patients with Chronic Kidney Disease (CKD) report sexual dysfunction to a large extent. The objective of this study was to investigate if CKD-stage and mode of treatment correlate to self-reported experience in sexual function before and after onset of symptomatic CKD in patients without active treatment, after transplantation or on dialysis. Participants (N = 234) answered a questionnaire on frequency of sexual desire, initiative, intercourse, erection (men) /vaginal lubrication (women), and orgasm, currently and compared with before onset of symptomatic CKD. Clinical data were taken from medical charts. Within-group differences in sexual function were compared for patients without active treatment (PreT), patients with a renal transplant (Tx) and patients on dialysis treatment (D). In a subgroup analysis, five patient groups were created based on mode of treatment and CKD stage. Between-group differences in sexual function were analyzed as differences in mean composite scores and 95% CI and were estimated using ordinary least square regression with robust standard errors. In the first analysis of the study, all CKD patients reported a decrease in the frequency of sexual desire, initiative, intercourse, erection (men)/vaginal lubrication (women), and orgasm (Bonferroni p < 0.001) compared to before disease onset, irrespective of treatment mode. In the subgroup analysis, when adjusting for sex and age, dialysis patients reported a statistically significant decrease in their average score of sexual function (−2.65; 95% CI: −4.19 to −1.11; p = 0.001) compared to patients without active treatment CKD 2–3 (the reference group). The self-reported experience of CKD-patients of a deteriorating sexual function over time correlates to treatment modality and CKD stage. It is important for health-care personnel to be aware of the patients' experience of a deterioration in sexual function over time regardless of treatment modalities.

    Citation: Jessica Fryckstedt, Mattias Norrbäck, Charlotte Kaviani, Britta Hylander. Chronic kidney disease report differently on change in sexual function dependent on treatment: a cohort study[J]. AIMS Medical Science, 2023, 10(2): 151-161. doi: 10.3934/medsci.2023013

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  • Patients with Chronic Kidney Disease (CKD) report sexual dysfunction to a large extent. The objective of this study was to investigate if CKD-stage and mode of treatment correlate to self-reported experience in sexual function before and after onset of symptomatic CKD in patients without active treatment, after transplantation or on dialysis. Participants (N = 234) answered a questionnaire on frequency of sexual desire, initiative, intercourse, erection (men) /vaginal lubrication (women), and orgasm, currently and compared with before onset of symptomatic CKD. Clinical data were taken from medical charts. Within-group differences in sexual function were compared for patients without active treatment (PreT), patients with a renal transplant (Tx) and patients on dialysis treatment (D). In a subgroup analysis, five patient groups were created based on mode of treatment and CKD stage. Between-group differences in sexual function were analyzed as differences in mean composite scores and 95% CI and were estimated using ordinary least square regression with robust standard errors. In the first analysis of the study, all CKD patients reported a decrease in the frequency of sexual desire, initiative, intercourse, erection (men)/vaginal lubrication (women), and orgasm (Bonferroni p < 0.001) compared to before disease onset, irrespective of treatment mode. In the subgroup analysis, when adjusting for sex and age, dialysis patients reported a statistically significant decrease in their average score of sexual function (−2.65; 95% CI: −4.19 to −1.11; p = 0.001) compared to patients without active treatment CKD 2–3 (the reference group). The self-reported experience of CKD-patients of a deteriorating sexual function over time correlates to treatment modality and CKD stage. It is important for health-care personnel to be aware of the patients' experience of a deterioration in sexual function over time regardless of treatment modalities.


    Abbreviations

    CKD:

    Chronic kidney disease; 

    CKD 1–5:

    Chronic kidney disease stage 1–5; 

    PreT:

    Pretreatment; 

    PreT 2–3:

    Pretreatment patients in CKD stages 2–3; 

    PreT 4–5:

    Pretreatment patients in CKD stages 4–5; 

    D:

    Dialysis; 

    Tx:

    Transplanted patients; 

    Tx 2–3:

    Patients with a renal transplant in CKD stages 2–3; 

    Tx 4–5:

    Patients with a renal transplant in CKD stages 4–5; 

    BMI:

    Body Mass Index; 

    GFR:

    Glomerular Filtration Rate; 

    IIEF:

    International Index of Erectile function questionnaire; 

    FSFI:

    Female Sexual Function Index questionnaire; 

    ED:

    Erectile Dysfunction; 

    RSS:

    Relationship and Sexuality Scale; 

    ACE:

    Angiotensin converting enzyme; 

    ARB:

    Angiotensin II receptor blockers; 

    PTH:

    Parathyroid Hormone; 

    OLS regression:

    Ordinary least square regression; 

    IQR:

    Interquartile range; 

    SLE:

    Systemic lupus erythematosus; 

    EPO:

    Erytropoietin

    Let A denote the class of functions f which are analytic in the open unit disk Δ={zC:|z|<1}, normalized by the conditions f(0)=f(0)1=0. So each fA has series representation of the form

    f(z)=z+n=2anzn. (1.1)

    For two analytic functions f and g, f is said to be subordinated to g (written as fg) if there exists an analytic function ω with ω(0)=0 and |ω(z)|<1 for zΔ such that f(z)=(gω)(z).

    A function fA is said to be in the class S if f is univalent in Δ. A function fS is in class C of normalized convex functions if f(Δ) is a convex domain. For 0α1, Mocanu [23] introduced the class Mα of functions fA such that f(z)f(z)z0 for all zΔ and

    ((1α)zf(z)f(z)+α(zf(z))f(z))>0(zΔ). (1.2)

    Geometrically, fMα maps the circle centred at origin onto α-convex arcs which leads to the condition (1.2). The class Mα was studied extensively by several researchers, see [1,10,11,12,24,25,26,27] and the references cited therein.

    A function fS is uniformly starlike if f maps every circular arc Γ contained in Δ with center at ζ Δ onto a starlike arc with respect to f(ζ). A function fC is uniformly convex if f maps every circular arc Γ contained in Δ with center ζ Δ onto a convex arc. We denote the classes of uniformly starlike and uniformly convex functions by UST and  UCV, respectively. For recent study on these function classes, one can refer to [7,9,13,19,20,31].

    In 1999, Kanas and Wisniowska [15] introduced the class k-UCV (k0) of k-uniformly convex functions. A function fA is said to be in the class k-UCV if it satisfies the condition

    (1+zf(z)f(z))>k|zf(z)f(z)|(zΔ). (1.3)

    In recent years, many researchers investigated interesting properties of this class and its generalizations. For more details, see [2,3,4,14,15,16,17,18,30,32,35] and references cited therein.

    In 2015, Sokół and Nunokawa [33] introduced the class MN, a function fMN if it satisfies the condition

    (1+zf(z)f(z))>|zf(z)f(z)1|(zΔ).

    In [28], it is proved that if (f)>0 in Δ, then f is univalent in Δ. In 1972, MacGregor [21] studied the class B of functions with bounded turning, a function fB if it satisfies the condition (f)>0 for zΔ. A natural generalization of the class B is B(δ1) (0δ1<1), a function fB(δ1) if it satisfies the condition

    (f(z))>δ1(zΔ;0δ1<1), (1.4)

    for details associated with the class B(δ1) (see [5,6,34]).

    Motivated essentially by the above work, we now introduce the following class k-Q(α) of analytic functions.

    Definition 1. Let k0 and 0α1. A function fA is said to be in the class k-Q(α) if it satisfies the condition

    ((zf(z))f(z))>k|(1α)f(z)+α(zf(z))f(z)1|(zΔ). (1.5)

    It is worth mentioning that, for special values of parameters, one can obtain a number of well-known function classes, some of them are listed below:

    1. k-Q(1)=k-UCV;

    2. 0-Q(α)=C.

    In what follows, we give an example for the class k-Q(α).

    Example 1. The function f(z)=z1Az(A0) is in the class k-Q(α) with

    k1b2bb(1+α)[b(1+α)+2]+4(b=|A|). (1.6)

    The main purpose of this paper is to establish several interesting relationships between k-Q(α) and the class B(δ) of functions with bounded turning.

    To prove our main results, we need the following lemmas.

    Lemma 1. ([8]) Let h be analytic in Δ with h(0)=1, β>0 and 0γ1<1. If

    h(z)+βzh(z)h(z)1+(12γ1)z1z,

    then

    h(z)1+(12δ)z1z,

    where

    δ=(2γ1β)+(2γ1β)2+8β4. (2.1)

    Lemma 2. Let h be analytic in Δ and of the form

    h(z)=1+n=mbnzn(bm0)

    with h(z)0 in Δ. If there exists a point z0(|z0|<1) such that |argh(z)|<πρ2(|z|<|z0|) and |argh(z0)|=πρ2 for some ρ>0, then z0h(z0)h(z0)=iρ, where

    :{n2(c+1c)(argh(z0)=πρ2),n2(c+1c)(argh(z0)=πρ2),

    and (h(z0))1/ρ=±ic(c>0).

    This result is a generalization of the Nunokawa's lemma [29].

    Lemma 3. ([37]) Let ε be a positive measure on [0,1]. Let ϝ be a complex-valued function defined on Δ×[0,1] such that ϝ(.,t) is analytic in Δ for each t[0,1] and ϝ(z,.) is ε-integrable on [0,1] for all zΔ. In addition, suppose that (ϝ(z,t))>0, ϝ(r,t) is real and (1/ϝ(z,t))1/ϝ(r,t) for |z|r<1 and t[0,1]. If ϝ(z)=10ϝ(z,t)dε(t), then (1/ϝ(z))1/ϝ(r).

    Lemma 4. ([22]) If 1D<C1, λ1>0 and (γ2)λ1(1C)/(1D), then the differential equation

    s(z)+zs(z)λ1s(z)+γ2=1+Cz1+Dz(zΔ)

    has a univalent solution in Δ given by

    s(z)={zλ1+γ2(1+Dz)λ1(CD)/Dλ1z0tλ1+γ21(1+Dt)λ1(CD)/Ddtγ2λ1(D0),zλ1+γ2eλ1Czλ1z0tλ1+γ21eλ1Ctdtγ2λ1(D=0).

    If r(z)=1+c1z+c2z2+ satisfies the condition

    r(z)+zr(z)λ1r(z)+γ21+Cz1+Dz(zΔ),

    then

    r(z)s(z)1+Cz1+Dz,

    and s(z) is the best dominant.

    Lemma 5. ([36,Chapter 14]) Let w, x and\ y0,1,2, be complex numbers. Then, for (y)>(x)>0, one has

    1. 2G1(w,x,y;z)=Γ(y)Γ(yx)Γ(x)10sx1(1s)yx1(1sz)wds;

    2. 2G1(w,x,y;z)= 2G1(x,w,y;z);

    3. 2G1(w,x,y;z)=(1z)w2G1(w,yx,y;zz1).

    Firstly, we derive the following result.

    Theorem 1. Let 0α<1 and k11α. If fk-Q(α), then fB(δ), where

    δ=(2μλ)+(2μλ)2+8λ4(λ=1+αkk(1α);μ=kαk1k(1α)). (3.1)

    Proof. Let f=, where is analytic in Δ with (0)=1. From inequality (1.5) which takes the form

    (1+z(z)(z))>k|(1α)(z)+α(1+z(z)(z))1|=k|1α(z)+α(z)αz(z)(z)|,

    we find that

    ((z)+1+αkk(1α)z(z)(z))>kαk1k(1α),

    which can be rewritten as

    ((z)+λz(z)(z))>μ(λ=1+αkk(1α);μ=kαk1k(1α)).

    The above relationship can be written as the following Briot-Bouquet differential subordination

    (z)+λz(z)(z)1+(12μ)z1z.

    Thus, by Lemma 1, we obtain

    1+(12δ)z1z, (3.2)

    where δ is given by (3.1). The relationship (3.2) implies that fB(δ). We thus complete the proof of Theorem 3.1.

    Theorem 2. Let 0<α1, 0<β<1, c>0, k1, nm+1(m N ), ||n2(c+1c) and

    |αβ±(1α)cβsinβπ2|1. (3.3)

    If

    f(z)=z+n=m+1anzn(am+10)

    and fk-Q(α), then fB(β0), where

    β0=min{β:β(0,1)}

    such that (3.3) holds.

    Proof. By the assumption, we have

    f(z)=(z)=1+n=mcnzn(cm0). (3.4)

    In view of (1.5) and (3.4), we get

    (1+z(z)(z))>k|(1α)(z)+α(1+z(z)(z))1|.

    If there exists a point z0Δ such that

    |arg(z)|<βπ2(|z|<|z0|;0<β<1)

    and

    |arg(z0)|=βπ2(0<β<1),

    then from Lemma 2, we know that

    z0(z0)(z0)=iβ,

    where

    ((z0))1/β=±ic(c>0)

    and

    :{n2(c+1c)(arg(z0)=βπ2),n2(c+1c)(arg(z0)=βπ2).

    For the case

    arg(z0)=βπ2,

    we get

    (1+z0(z0)(z0))=(1+iβ)=1. (3.5)

    Moreover, we find from (3.3) that

    k|(1α)(z0)+α(1+z0(z0)(z0))1|=k|(1α)((z0)1)+αz0(z0)(z0)|=k|(1α)[(±ic)β1]+iαβ|=k(1α)2(cβcosβπ21)2+[αβ±(1α)cβsinβπ2]21. (3.6)

    By virtue of (3.5) and (3.6), we have

    (1+z(z0)(z0))k|(1α)(z0)+α(1+z0(z0)(z0))1|,

    which is a contradiction to the definition of k-Q(α). Since β0=min{β:β(0,1)} such that (3.3) holds, we can deduce that fB(β0).

    By using the similar method as given above, we can prove the case

    arg(z0)=βπ2

    is true. The proof of Theorem 2 is thus completed.

    Theorem 3. If 0<β<1 and 0ν<1. If fk-Q(α), then

    (f)>[2G1(2β(1ν),1;1β+1;12)]1,

    or equivalently, k-Q(α)B(ν0), where

    ν0=[2G1(2β(1μ),1;1β+1;12)]1.

    Proof. For

    w=2β(1ν), x=1β, y=1β+1,

    we define

    ϝ(z)=(1+Dz)w10tx1(1+Dtz)wdt=Γ(x)Γ(y) 2G1(1,w,y;zz1). (3.7)

    To prove k-Q(α)B(ν0), it suffices to prove that

    inf|z|<1{(q(z))}=q(1),

    which need to show that

    (1/ϝ(z))1/ϝ(1).

    By Lemma 3 and (3.7), it follows that

    ϝ(z)=10ϝ(z,t)dε(t),

    where

    ϝ(z,t)=1z1(1t)z(0t1),

    and

    dε(t)=Γ(x)Γ(w)Γ(yw)tw1(1t)yw1dt,

    which is a positive measure on [0,1].

    It is clear that (ϝ(z,t))>0 and ϝ(r,t) is real for |z|r<1 and t[0,1]. Also

    (1ϝ(z,t))=(1(1t)z1z)1+(1t)r1+r=1ϝ(r,t)

    for |z|r<1. Therefore, by Lemma 3, we get

    (1/ϝ(z))1/ϝ(r).

    If we let r1, it follows that

    (1/ϝ(z))1/ϝ(1).

    Thus, we deduce that k-Q(α)B(ν0).

    Theorem 4. Let 0α<1 and k11α. If fk-Q(α), then

    f(z)s(z)=1g(z),

    where

    g(z)=2G1(2λ,1,1λ+1;zz1)(λ=1+αkk(1α)).

    Proof. Suppose that f=. From the proof of Theorem 1, we see that

    (z)+z(z)1λ(z)1+(12μ)z1z1+z1z(λ=1+αkk(1α);μ=kαk1k(1α)).

    If we set λ1=1λ, γ2=0, C=1 and D=1 in Lemma 4, then

    (z)s(z)=1g(z)=z1λ(1z)2λ1/λz0t(1/λ)1(1t)2/λdt.

    By putting t=uz, and using Lemma 5, we obtain

    (z)s(z)=1g(z)=11λ(1z)2λ10u(1/λ)1(1uz)2/λdu=[2G1(2λ,1,1λ+1;zz1)]1,

    which is the desired result of Theorem 4.

    The present investigation was supported by the Key Project of Education Department of Hunan Province under Grant no. 19A097 of the P. R. China. The authors would like to thank the referees for their valuable comments and suggestions, which was essential to improve the quality of this paper.

    The authors declare no conflict of interest.


    Acknowledgments



    Many thanks to the collaborators below who contributed in recruiting patients from their respective Nephology Units: Lilian Zezina, MD, PhD, Mälarsjukhuset, Eskilstuna; Michael Gylling, RN, Anders Fernström, MD, PhD, Linköping University Hospital; Sonia Osagie, MD, Nyköping Hospital; Boa Grönroos, MD, Danderyd Hospital; Gunilla Welander, MD, Karlstad Hospital.

    Use of AI tools declaration



    The authors declare they have not used Artificial Intelligence (AI) tools in the creation of this article.

    Conflict of interest



    All authors declare no conflict of interest in this paper.

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