Advanced chronic kidney disease is associated with impaired spermatogenesis and testicular damage. Semen analysis typically shows a decreased volume of ejaculate, oligo- or complete azoospermia, and a low percentage of motile sperm. Erectile dysfunction (ED) is also common in patients with chronic renal failure (CRF) and is observed in excess of 50% of these patients. There have been ongoing improvements in survival and quality of life after renal transplantation. One of the most impressive aspects of successful renal transplantation in the young people is the ability of the male patient to father a child. In this article we first review pathophysiology of reproductive failure in end-stage renal disease (ESRD), then ED in ESRD and its management are discussed, finally sexual function in renal transplant patients and management of ED in these patients are reviewed.
Erectile Dysfunction ; therapy ; Humans ; Kidney Failure, Chronic ; physiopathology ; surgery ; Kidney Transplantation ; Male ; Reproduction

INTRODUCTIONThe number of patients suffering from chronic kidney disease (CKD) is increasing worldwide. Hyperphosphataemia and high serum calcium (Ca) and phosphorus (P) product contribute to the substantial increase in cardiovascular events in CKD patients. Although reports of CKD complications in Iranian haemodialysis (HD) patients are comparable to data from other developed countries, management of these complications has failed to meet generally accepted targets. This study evaluated the impact of clinical pharmacy services in the management of complications in HD patients.

METHODSDuring a six-month prospective study, clinical pharmacists conducted medical visits in the HD ward and adjusted the patients' medications according to their laboratory findings.

RESULTSSerum Ca concentration was increased in hypocalcaemia patients and decreased in hypercalcaemia patients until it reached the optimal range in both groups. A decline in serum P level was noted in hyperphosphataemia patients, although it did not reach the target range. The Ca × P product decreased in patients with Ca × P > 55 mg2/dL2. Although it did not reach the goal, there was an increase and decrease in serum intact parathyroid hormone (iPTH) concentration in suboptimal and supraoptimal range patients, respectively. Serum Ca, P and iPTH levels did not change in patients with optimal values at the initiation of the study. Haemoglobin concentration increased in anaemic patients and serum ferritin reached target values in all patients. Total cholesterol, low-density lipoprotein cholesterol and triglycerides decreased to near-optimal values in dyslipidaemia patients.

CONCLUSIONThis study showed that clinical pharmacy services at the HD centre can improve the management of complications in CKD patients.

Adult ; Aged ; Aged, 80 and over ; Anemia ; etiology ; prevention & control ; Bone Diseases, Metabolic ; etiology ; prevention & control ; Dyslipidemias ; etiology ; prevention & control ; Female ; Humans ; Iran ; Male ; Medication Adherence ; Middle Aged ; Pharmacy Service, Hospital ; Practice Guidelines as Topic ; Prospective Studies ; Reference Standards ; Renal Dialysis ; adverse effects ; Renal Insufficiency, Chronic ; complications ; therapy