Cytokine profiles in patients with chronic kidney disease and low sexual function

Low sexual function is common in chronic kidney disease (CKD), yet the contribution of inflammatory pathways in affected women remains poorly defined. We sought to characterize cytokine profiles associated with low sexual function in women with advanced CKD. We enrolled 32 women aged 18-51 yr with CKD stages 3b-5 in a cross-sectional study assessing hormonal profiles and sexual function using the Female Sexual Function Index (FSFI); low sexual function was defined as FSFI <26.55. Plasma samples were analyzed using a 48-plex cytokine assay. Cytokine concentrations were compared using the Wilcoxon two-sample test, with false discovery rate control (FDR <0.05) via the Benjamin-Hochberg procedure. Principal component analysis (PCA) was used to evaluate cytokine patterns associated with low sexual function. : Thirty participants completed the FSFI; 22 (73%) met criteria for low sexual function. Of 48 cytokines examined, soluble CD40 ligand (sCD40L) was the only marker that remained significant after FDR correction, with lower levels observed in women with low sexual function (median 520.9 vs. 1,140 pg/mL; P = 0.0004; FDR = 0.02). Each 100 pg/mL increase in sCD40L was associated with a 34% reduction in odds of having low sexual function after adjusting for age and estimated glomerular filtration rate [adjusted odds ratio (OR) 0.66; 95% confidence interval (CI) 0.49-0.90]. PCA revealed that principal component 1 explained 37.4% of the variance, and higher levels were associated with a higher odds of low sexual function (OR 1.42; 95% CI 1.03-1.96). Low sexual function was highly prevalent and associated with differences in inflammatory and immune signaling, suggesting immune-vascular pathways may influence female sexual health in CKD.NEW & NOTEWORTHY This study is the first to investigate cytokine profiles in women with advanced CKD and low sexual function. We found that lower levels of soluble CD40 ligand were independently linked to higher odds of having low sexual function. Principal component analysis demonstrated that a broader immune activation pattern was associated with higher odds of having low sexual function. Together, these findings suggest that immune signaling patterns may be relevant to sexual health in women with CKD.