Sexual dysfunction predicts depression among women on hemodialysis

Depression is common in patients on hemodialysis (HD), and its treatment fails in many cases. Among women on HD, sexual dysfunction (SD) can be an underestimated cause of depression and an impending factor for successful therapy. We aimed to evaluate the association between SD and depression among end-stage renal disease (ESRD) women undergoing HD and to test SD as an independent predictor of depression.

We studied 55 ESRD women undergoing HD from a single renal unit. We compared sociodemographic, clinical and laboratory data and presence of SD between depressed and non-depressed participants, and tested SD as an independent predictor of depression. Demographic data, time on dialysis, underlying etiology of ESRD and laboratory results were assessed in renal unit records. Classification of economic class was according to the criteria of the Brazilian Association of Research Institutes. Each participant was assigned a low-, medium- or high-risk index based on comorbidity. Depression was classified by the 20-Item Version of the Center for Epidemiologic Studies Depression Scale using a score ≥18 to classify depression. The Female Sexual Function Index was used to evaluate sexual function considering a cutoff of 26 to classify SD.

Thirty-three (56.8 %) women were depressive and 46 (79.3 %) women presented SD. Depressed an non-depressed women did not differ in sociodemographic, clinical and laboratory results, but the prevalence of SD among depressed patients was higher compared to non-depressed women, respectively, 90.1 versus 64 % (p = 0.029). SD was an independent predictor of depression (OR = 5.62; CI 95 % 1.33-23.7; p = 0.01).

SD must be discarded among women on HD classified as depressive. Treatment of depression among women with SD should include a specific approach to SD.