İnfertilite, Seksüel Fonksiyon Bozuklukları ve Kanıta Dayalı Tedavi Bakım Uygulamaları
Özet
Literatürde, hemodiyaliz hastalarında cinsel işlev bozuklukları ve infertilite problemlerinin cinsiyet farkı gözetmeksizin yüksek oranlarda ve benzer biçimlerde görüldüğü bildirilmektedir. Bu durum, bireylerin yaşam kalitesinde azalma, psikososyal uyumda güçlükler ve artan bakım gereksinimleriyle belirginleşmektedir. Hemşireler, cinsel sağlık ve üreme sağlığına ilişkin sorunların erken fark edilmesi, sistematik değerlendirilmesi ve uygun danışmanlıkla bakım girişimlerinin planlanmasında kritik bir role sahiptir. Kanıta dayalı uygulamalar, hemodiyaliz hastalarının cinsel sağlık ve üreme sağlığına ilişkin gereksinimlerinin bütüncül bir yaklaşımla ele alınmasını kolaylaştırarak yaşam kalitesini artırmakta ve hemşirelik bakımının etkinliğini güçlendirmektedir. Bu bölüm, kronik böbrek yetersizliği ve hemodiyalizin üreme sağlığı üzerindeki kapsamlı etkilerini ele alarak, bu alandaki mevcut literatür bilgilerini derlemeyi ve sağlık profesyonellerinin farkındalığını artırmayı amaçlamaktadır.
Referanslar
Ahmed SB, Ramesh S. Sex hormones in women with kidney disease. Nephrology Dialysis Transplantation, 2016; 31(11):1787–1795 https://doi.org/10.1093/ndt/gfw084
Kuczera P, Więcek A, Adamczak M. Impaired fertility in women and men with chronic kidney disease. Advances in Clinical and Experimental Medicine, 2022; 31(2): 187-195. doi: 10.17219/acem/141188.
Palmer BF, Clegg DJ. Gonadal dysfunction in chronic kidney disease. Reviews in Endocrine and Metabolic Disorders, 2017; 18: 117–130. doi: https://doi.org/10.1007/s11154-016-9385-9
Bhaduri M, Sarris I, Bramham K. Female infertility in chronic kidney disease. Diagnostics, 2023; 13(20): 3216-3226. doi: 10.3390/diagnostics13203216.
Piccoli GB, Zakharova E, Attini R, et al. Pregnancy in chronic kidney disease: need for higher awareness. A pragmatic review focused on what could be improved in the different CKD stages and phases. Journal of Clinical Medicine, 2018; 7(11): 415, 436. doi:10.3390/jcm7110415
Dumanski SM, Ahmed SB. Fertility and reproductive care in chronic kidney disease. Journal of Nephrology, 2019; 32(1):39–50. https://doi.org/10.1007/s40620-018-00569-9
Reynolds ML, Loehr LR, Hogan SL, et al. Prevalence of infertility and pregnancy loss among individuals with kidney disease in the hispanic community health study/study of latinos. Women's Health, 2024; (20). https://doi.org/10.1177/17455057231224544
Saglimbene V, Natale P, Palmer S, et al. The prevalence and correlates of low sexual functioning in women on hemodialysis: A multinational, cross-sectional study. Plos One, 2017; 12(6): 1-12. https://doi.org/10.1371/journal.pone.0179511
Navaneethan SD, Vecchio M, Johnson,DW, et al. Prevalence and correlates of self-reported sexual dysfunction in CKD: A meta-analysis of observational studies. American Journal of Kidney Diseases, 2010; 56(4):670-685. doi: 10.1053/j.ajkd.2010.06.016
Pyrgidis N, Mykoniatis I, Tishukov M, et al. Sexual dysfunction in women with end-stage renal disease: a systematic review and meta-analysis. The Journal of Sexual Medicine, 2021; 18(5): 936-945. doi: 10.1016/j.jsxm.2021.02.008.
Luo L, Xiao C, Xiang Q, et al. Significant increase of sexual dysfunction in patients with renal failure receiving renal replacement therapy: A systematic review and meta-analysis. The Journal of Sexual Medicine, 2020;17(12):2382-2393. doi: 10.1016/j.jsxm.2020.08.019
Fu R, He P, Hong W, et al. Male sexual dysfunction in patients with chronic kidney disease: a cross-sectional study. Scientific Reports, 2024; 14(1), 9207-9217. doi: 10.1038/s41598-024-59844-4.
Demiroğlu S, Bülbül E. Hemodiyaliz tedavisi alan hastaların depresyon, anksiyete, stres durumları ve diyaliz semptomlarıyla ilişkisi. Nefroloji Hemşireliği Dergisi, 2021; 16(3): 124-133. doi: https://doi.org/10.47565/ndthdt.2021.40
Guven S, Sarı F, Inci, A, ve ark. Sexual dysfunction is associated with depression and anxiety in patients with predialytic chronic kidney disease. The Eurasian Journal of Medicine, 2018; 50(2): 75-80. doi: 10.5152/eurasianjmed.2018.17152
Balaban ÖD, Aydin E, Keyvan A, ve ark. Hemodiyaliz uygulanan hastalarda psikiyatrik komorbidite, cinsel işlev bozukluğu ve yaşam kalitesi: bir vaka kontrol çalışması. Arsiv Noropsikiyatri, 2017; 54(2):137-142. doi: 10.5152/npa.2016.12677
Jarullah FA, Yaseen M, Abdullah H, et al. Erectile dysfunction and associated anxiety and depression in male hemodialysis patients: A cross-sectional study at Karachi Institute of kidney diseases. Cureus, 2020; 12(10): 11129-11135. doi: 10.7759/cureus.11129
Peng YS, Chiang CK, Kao, TW, et al. Sexual dysfunction in female hemodialysis patients: A multicenter study. Kidney İnternational, 2005;68(2):760-765. https://doi.org/10.1016/S0085-2538(15)50896-X
Peng YS, Chiang CK, Hung K Y, et al. The association of higher depressive symptoms and sexual dysfunction in male haemodialysis patients. Nephrology Dialysis Transplantation, 2007; 22(3): 857-861. doi: 10.1093/ndt/gfl666
Yaqoob S, Yaseen M, Abdullah H, et al. Sexual dysfunction and associated anxiety and depression in female hemodialysis patients: a cross-sectional study at Karachi Institute of kidney diseases. Cureus, 2020; 12(8): 1-7. e10148. doi: 10.7759/cureus.10148.
Shah SAY, Sajjad W, Hassan WU, et al. Sexual dysfunction in female patients undergoing hemodialysis and its relationship with anxiety and depression. Cureus, 2022; 14(10):1-7. e29883. doi: 10.7759/cureus.29883
Ramesh S, James MT, Holroyd-Leduc JM, et al. Sex hormone status in women with chronic kidney disease: survey of nephrologists’ and renal allied health care providers’ perceptions. Canadian Journal of Kidney Health and Disease, 2017; 4:1-13. doi:10.1177/2054358117734534
Piccoli GB, Minelli F, Versino E, et al. Pregnancy in dialysis patients in the new millennium: A systematic review and meta-regression analysis correlating dialysis schedules and pregnancy outcomes. Nephrology Dialysis Transplantation, 2016, 31(11): 1915-1934. https://doi.org/10.1093/ndt/gfv395
Bardhi E, Drakopoulos P. Update on male infertility. Journal of Clinical Medicine, 2021; 10(20): 1-3. https://doi.org/10.3390/jcm10204771
Eckersten D, Tsatsanis C, Giwercman A, et al. MicroRNA-155 and anti-müllerian hormone: New potential markers of subfertility in men with chronic kidney disease. Nephron Extra, 2017; 7(1): 33-41. https://doi.org/10.1159/000458711
Lehtihet M, Hylander B. Semen quality in men with chronic kidney disease and its correlation with chronic kidney disease stages. Andrologia, 2015; 47(10): 1103-1108. doi:10.1111/and.12388
Zachoval R, Jarabak J, Slatinska J, et al. Dynamics of fertility in patients on waiting list for kidney transplantation. Bratislavske Lekarske Listy, 2013; 114(12): 711-715. https://doi.org/10.4149/bll_2013_150
Hampel C, Artibani W, Pons ME, et al. Understanding the burden of stress urinary incontinence in Europe: A qualitative review of the literature. European Urology, 2004; 46(1): 15-27. doi: 10.1016/j.eururo.2004.02.003
Giuliano FA, Leriche A, Jaudinot EO, et al. Prevalence of erectile dysfunction among 7689 patients with diabetes or hypertension, or both. Urology, 2004; (6):1196-1201. https://doi.org/10.1016/j.urology.2004.08.059
Chrysant SG. Antihypertensive therapy causes erectile dysfunction. Current Opinion in Cardiology, 2015; 30(4). 383-390. doi: 10.1097/HCO.0000000000000189
Kupelian V. Hall SA, McKinlay JB. Common prescription medication use and erectile dysfunction: Results from the Boston Area Community Health (BACH) survey. BJU İnternational, 2013; 112(8): 1178-1187. https://doi.org/10.1111/bju.12231
Fung MM, Bettencourt R, Barrett-Connor E. Heart disease risk factors predict erectile dysfunction 25 years later: The Rancho Bernardo Study. Journal of the American College of Cardiology, 2004; 43(8):1405-1411. doi:10.1016/j.jacc.2003.11.041
Chrysant SG. Antihypertensive therapy causes erectile dysfunction. Current Opinion in Cardiology, 2015; 30(4): 383-390. doi: 10.1097/HCO.0000000000000189
Lim VS, Henriquez C, Sievertsen G, et al. Ovarian function in chronic renal failure: evidence suggesting hypothalamic anovulation. Annals of İnternal Medicine, 1980; 93(1): 21-27. doi:10.7326/0003-4819-93-1-21
Matuszkiewicz-Rowińska J, Skórzewska K, Radowicki S, et al. Endometrial morphology and pituitary-gonadal axis dysfunction in women of reproductive age undergoing chronic haemodialysis—a multicentre study. Nephrology Dialysis Transplantation, 2004; 19(8): 2074-2077. https://doi.org/10.1093/ndt/gfh279
Zengin O, Yıldırım B. Hemodiyaliz hastalarının psikososyal sorunlarına ilişkin algıları. Türk Nefroloji Diyaliz ve Transplantasyon Dergisi, 2017; 26(1): 67-73. doi: 10.5262/tndt.2017.1001.11
Rojas R, Clegg D J, Palmer B F. Amenorrhea and estrogen disorders in kidney disease. In Seminars in Nephrology, 2021,41(2): 126-132. https://doi.org/10.1016/j.semnephrol.2021.03.007
Ahmed SB, Vitek WS, Holley JL. Fertility, contraception, and novel reproductive technologies in chronic kidney disease. Seminars in Nephrology, 2017, 37(4): 327-336. https://doi.org/10.1016/j.semnephrol.2017.05.004
Sievertsen GD, Lım VS, Nakawatase,C, et al Metabolic clearance and secretion rates of human prolactin in normal subjects and in patients with chronic renal failure. The Journal of Clinical Endocrinology & Metabolism, 1980; 50(5): 846-852. https://doi.org/10.1210/jcem-50-5-846
Kaprara A, Huhtaniemi I T. The hypothalamus-pituitary-gonad axis: Tales of mice and men. Metabolism, 2018; 86:3-17. https://doi.org/10.1016/j.metabol.2017.11.018
Hotaling JM, Patel Z. Male endocrine dysfunction. Urologic Clinics, 2014; 41(1):39-53. doi: 10.1016/j.ucl.2013.08.010
Vander Borght M, Wyns C. Fertility and infertility: Definition and epidemiology. ClinicalBiochemistry, 2018;62:2-10. https://doi.org/10.1016/j.clinbiochem.2018.03.012
Demir CA. Özer Z. Hemodiyaliz tedavisi alan hastalarda semptom ve konfor ilişkisi. Nefroloji Hemşireliği Dergisi, 2022; 17(1): 10-27. https://doi.org/10.47565/ndthdt.2022.49
Akgöz N, Arslan S. Hemodiyaliz tedavisi alan hastalarda yaşanan semptomların incelenmesi. Nefroloji Hemşireliği Dergisi, 2017; 12(1):20-28
Yılmaz FT, Sert H, Kumsar AK, ve ark. Hemodiyaliz tedavisi alan hastaların umut düzeyleri, semptom kontrolü ve tedaviye uyumlarının değerlendirilmesi. Acıbadem Üniversitesi Sağlık Bilimleri Dergisi, 2020; (1): 35-43. https://doi.org/10.31067/0.2019.197
Ati N, El Ati Z, Bannour I. Et al. Hypogonadism in hemodialysis patients: A first snapshot of prevalence and predictive factors in Tunisian patients. Pan African Medical Journal, 2023; 46(1): 1-12. doi: 10.11604/pamj.2023.46.63.39794
Wilkosz,P, Greggains G D, Tanbo TG, et al. Female reproductive decline is determined by remaining ovarian reserve and age. Plos One, 2014;9(10):1-7 https://doi.org/10.1371/journal.pone.0108343
Iwase A, Nakamura T, Osuka S., et al. Anti-Müllerian hormone as a marker of ovarian reserve: What have we learned, and what should we know? Reproductive Medicine and Biology, 2016; 15:127-136. doi: 10.1007/s12522-015-0227-3
Stoumpos S, Lees J, Welsh P, et al. Hund, M., Geddes, C. C., Nelson, S. M., & Mark, P. B. The utility of anti-Müllerian hormone in women with chronic kidney disease, on haemodialysis and after kidney transplantation. Reproductive BioMedicine Online, 2018; 36(2): 219-226. https://doi.org/10.1016/j.rbmo.2017.11.003
Sikora-Grabka E, Adamczak M. Kuczera P, et al. Serum anti-Müllerian hormone concentration in young women with chronic kidney disease on hemodialysis, and after successful kidney transplantation. Kidney and Blood Pressure Research, 2016; 41(5): 552-560. https://doi.org/10.1159/000443458
Tainio J, Jahnukainen K, Nurmio M, et al. Testicular function, semen quality, and fertility in young men after renal transplantation during childhood or adolescence. Transplantation, 2014;98(9):987–993. Doi:10.1097/TP.0000000000000173
Van Eps C, Hawley C, Jeffries J, et al. Changes in serum prolactin, sex hormones and thyroid function with alternate nightly nocturnal home haemodialysis. Nephrology, 2012;17(1):42-47. https://doi.org/10.1111/j.1440-1797.2011.01520.x
Iglesias P, Carrero J J, Díez, JJ. Gonadal dysfunction in men with chronic kidney disease: Clinical features, prognostic implications and therapeutic options. Journal of Nephrology, 2012; 25(1): 31-42. doi: 10.5301/JN.2011.8481
Segraves RT, Balon R. Antidepressant-induced sexual dysfunction in men. Pharmacology Biochemistry and Behavior, 2014;121:132-137. https://doi.org/10.1016/j.pbb.2013.11.003
Zhang XW, Li C, Ma XX, et al. Short-interval lower-dose intravenous cyclophosphamide as induction and maintenance therapy for lupus nephritis: A prospective observational study. Clinical Rheumatology, 2014; 33:939-945. https://doi.org/10.1007/s10067-014-2590-6
Sullivan-Pyke CS, Senapati S, Mainigi MA, et al. In vitro fertilization and adverse obstetric and perinatal outcomes. In Seminars in Perinatology, 2017,41(6): 345-353. https://doi.org/10.1053/j.semperi.2017.07.001
Yo JH, Orozco-Guillén A, Genest DS, et al. A Multinational Cohort Study of Dialysis Initiation During Pregnancy. Kidney Int Rep. 2025,1;10(7):2202-2212. doi: 10.1016/j.ekir.2025.03.057.
Gorayeb-Polacchini FS, Moura AF, Luders C, et al. Pregnancy in patients with chronic kidney disease undergoing dialysis. J Bras Nefrol. 2024; 46(4): e20240067. doi: 10.1590/2175-8239-JBN-2024-0067en. Attini, R., Leone, F., Parisi, S., Fassio, F., et al. Pregnancy on dialysis: A narrative review of the literature. Journal of Nephrology, 2023, 36(1): 79–97. https://doi.org/10.1007/s40620-022-01490-y
Attini R, Cabiddu G, Ciabatti F. et al. Chronic kidney disease, female infertility and medically assisted reproduction: A best practice position statement by the Kidney and Pregnancy Group of the Italian Society of Nephrology. J Nephrol 2023; 36: 1239–1255. https://doi.org/10.1007/s40620-023-01670-4
Mi-Kyoung C, Shin G. Gender-based experiences on the survival of chronic renal failure patients under hemodialysis for more than 20 years, Applied Nursing Research, 2016; 32(11): 262-268
Ceylan H, Yangöz ST, Özer Z. Coping strategies and its relationship with sexual dysfunction in adults receiving haemodialysis and peritoneal dialysis: A cross-sectional study. Journal of Clinical Nursing. 2024, 33(4), 1421–1431. https://doi.org/10.1111/jocn.16930
Dedemoglu S, Ince S. Sexuality Perceptions and Sexual Care Needs of Patients with Type 1 Diabetes Mellitus: A Mixed Methods Study. Sex Disabil. 2023, 41, 785–804. https://doi.org/10.1007/s11195-023-09803-0
Imhof S, Baggio Nerbass F, dos Santos RF. et. al Sexuality in female patients on hemodialysis: A scoping review, Sexual Medicine Reviews, 2025; qeaf059, https://doi.org/10.1093/sxmrev/qeaf059