ORIGINAL ARTICLE
Semen quality in men with chronic kidney disease and its correlation with chronic kidney disease stages M. Lehtihet1 & B. Hylander2 1 Department of Medicine, Karolinska Institute and Centre for Andrology and Sexual Medicine, Karolinska University Hospital, Huddinge, Sweden; 2 Department of Nephrology, Karolinska Institute and Karolinska University Hospital Solna, Stockholm, Sweden
Keywords Chronic kidney disease—semen quality— subfertility Correspondence Mikael Lehtihet, Department of Medicine, Karolinska Institute and Centre for Andrology and Sexual Medicine, Karolinska University Hospital C2:84 SE 141 86 Huddinge, Sweden. Tel.: +46858584773; Fax: +468 5858 7076; E-mail: [email protected] Accepted: October 12, 2014 doi: 10.1111/and.12388
Summary The aim of this study was to assess whether chronic kidney disease (CKD) has any impact on semen quality parameters in men with CKD stage 1–5. Results were collected from 66 men with different CKD stages (age 18–50 years). Age and BMI (body mass index) were recorded for each male. Higher CKD stage had a significant negative linear trend on semen volume (P < 0.05), progressive motility (P < 0.01), nonprogressive motility (P < 0.001), sperm concentration (P < 0.01), total sperm number (P < 0.01), cytoplasmic droplets (P < 0.01), teratozoospermia index (P < 0.05) and accessory gland markers, a-glucosidase activity (P < 0.05), zinc (P < 0.01) and fructose (P < 0.01). BMI per se had no significant effect on semen volume, sperm number, sperm concentration, morphology, a-glucosidase activity, fructose concentration or zinc level. A significant negative correlation between BMI and sexual-hormone-binding globulin (SHBG) (P < 0.01) was observed but not with other sex hormones. Age per se was related to a significant decrease of sperm concentration (P < 0.05), normal forms (P < 0.01) and testosterone level (P < 0.05). Our results indicate that CKD stage per se is a factor determining the number of spermatozoa available in the epididymis for ejaculation, in part independent of age-related decrease of testosterone level and BMI.
Introduction Subfertility is a common problem affecting 10–15% of all couples trying to conceive (Louis et al., 2013). Male factor subfertility accounts for 25–50% of all cases, of which in the majority no apparent cause can be found (Eisenberg et al., 2013). Subfertility is a frequent finding in male patients with chronic kidney disease (CKD) caused by multiple reasons: sexual dysfunction, loss of libido, impaired spermatogenesis, impaired gonadal steroidogenesis, arteriosclerosis, neuropathy, hypertension and medication, (Lessan-Pezeshki & Ghazizadeh, 2008). In men with CKD gonadal dysfunctions accompanied by elevation of serum gonadotropin concentration are frequent findings, affecting 26–66% of men with different stages of CKD (Iglesias et al., 2012). For haemodialysis patients, male fertility and quality of semen are significantly poorer than in healthy and infertile men, although some improvement of fertility occurs after renal transplantation (Shiraishi et al., 2008; Xu et al., © 2014 Blackwell Verlag GmbH Andrologia 2014, xx, 1–6
2012a). In recent years, there has been an increase in men fathering children at older age than in the past (Prioux, 2005). As a consequence, it is likely that an increasing number of older men with accidental findings of CKD will seek fertility units for primary or secondary male infertility. Older age and patients with CKD comorbidity also increase the likelihood of less frequent coitus among men and may impair fertility (Perlis et al., 2013). The semen quality declines with ageing, in volume, concentration and motility already from 35 to 40 years of age. Most studies of male fertility in men with CKD have been focused on patients with end-stage renal disease (CKD 5 without dialysis) and patients on haemodialysis, and there is little information about sperm quality throughout the CKD stages. This study analysed aspects of semen quality among a subgroup of men between 18 and 50 years old with CKD 1–5 stage, not treated with haemodialysis and furthermore the impact of sex hormones, age and BMI. 1
Chronic kidney disease and semen parameters
M. Lehtihet and B. Hylander
Material and methods Subjects Patients with different CKD stages aged 18–50 years from the Department of Nephrology, Karolinska University Hospital Solna, Stockholm, Sweden, were recruited from December 2012 to December 2013 and divided into five groups according to their stage of renal impairment (CKD 1–CKD 5). Staging of CKD was defined according to the presence or absence of kidney damage and level of kidney function, irrespective of the type of kidney disease (diagnosis) (National Kidney, 2002), according to Table 1. CKD stage was further based on creatinine–cystatin C equation for estimated glomerular filtration rate (eGFR) (Inker et al., 2012). Of the 101 men questioned, 66 volunteered to provide semen samples and fasting blood sample. In Table 1, study characteristics of the participants are included. The time between blood test and semen sample did not exceed 2 weeks for any of the participants. No participants were included, if they were smoker or former smokers (>3 months), had type 1 or type 2 diabetes mellitus, had a previous renal transplantation, were treated with testosterone replacement therapy, had already known infertility and/or had sexual abstinence
Semen quality in men with chronic kidney disease and its correlation with chronic kidney disease stages M. Lehtihet1 & B. Hylander2 1 Department of Medicine, Karolinska Institute and Centre for Andrology and Sexual Medicine, Karolinska University Hospital, Huddinge, Sweden; 2 Department of Nephrology, Karolinska Institute and Karolinska University Hospital Solna, Stockholm, Sweden
Keywords Chronic kidney disease—semen quality— subfertility Correspondence Mikael Lehtihet, Department of Medicine, Karolinska Institute and Centre for Andrology and Sexual Medicine, Karolinska University Hospital C2:84 SE 141 86 Huddinge, Sweden. Tel.: +46858584773; Fax: +468 5858 7076; E-mail: [email protected] Accepted: October 12, 2014 doi: 10.1111/and.12388
Summary The aim of this study was to assess whether chronic kidney disease (CKD) has any impact on semen quality parameters in men with CKD stage 1–5. Results were collected from 66 men with different CKD stages (age 18–50 years). Age and BMI (body mass index) were recorded for each male. Higher CKD stage had a significant negative linear trend on semen volume (P < 0.05), progressive motility (P < 0.01), nonprogressive motility (P < 0.001), sperm concentration (P < 0.01), total sperm number (P < 0.01), cytoplasmic droplets (P < 0.01), teratozoospermia index (P < 0.05) and accessory gland markers, a-glucosidase activity (P < 0.05), zinc (P < 0.01) and fructose (P < 0.01). BMI per se had no significant effect on semen volume, sperm number, sperm concentration, morphology, a-glucosidase activity, fructose concentration or zinc level. A significant negative correlation between BMI and sexual-hormone-binding globulin (SHBG) (P < 0.01) was observed but not with other sex hormones. Age per se was related to a significant decrease of sperm concentration (P < 0.05), normal forms (P < 0.01) and testosterone level (P < 0.05). Our results indicate that CKD stage per se is a factor determining the number of spermatozoa available in the epididymis for ejaculation, in part independent of age-related decrease of testosterone level and BMI.
Introduction Subfertility is a common problem affecting 10–15% of all couples trying to conceive (Louis et al., 2013). Male factor subfertility accounts for 25–50% of all cases, of which in the majority no apparent cause can be found (Eisenberg et al., 2013). Subfertility is a frequent finding in male patients with chronic kidney disease (CKD) caused by multiple reasons: sexual dysfunction, loss of libido, impaired spermatogenesis, impaired gonadal steroidogenesis, arteriosclerosis, neuropathy, hypertension and medication, (Lessan-Pezeshki & Ghazizadeh, 2008). In men with CKD gonadal dysfunctions accompanied by elevation of serum gonadotropin concentration are frequent findings, affecting 26–66% of men with different stages of CKD (Iglesias et al., 2012). For haemodialysis patients, male fertility and quality of semen are significantly poorer than in healthy and infertile men, although some improvement of fertility occurs after renal transplantation (Shiraishi et al., 2008; Xu et al., © 2014 Blackwell Verlag GmbH Andrologia 2014, xx, 1–6
2012a). In recent years, there has been an increase in men fathering children at older age than in the past (Prioux, 2005). As a consequence, it is likely that an increasing number of older men with accidental findings of CKD will seek fertility units for primary or secondary male infertility. Older age and patients with CKD comorbidity also increase the likelihood of less frequent coitus among men and may impair fertility (Perlis et al., 2013). The semen quality declines with ageing, in volume, concentration and motility already from 35 to 40 years of age. Most studies of male fertility in men with CKD have been focused on patients with end-stage renal disease (CKD 5 without dialysis) and patients on haemodialysis, and there is little information about sperm quality throughout the CKD stages. This study analysed aspects of semen quality among a subgroup of men between 18 and 50 years old with CKD 1–5 stage, not treated with haemodialysis and furthermore the impact of sex hormones, age and BMI. 1
Chronic kidney disease and semen parameters
M. Lehtihet and B. Hylander
Material and methods Subjects Patients with different CKD stages aged 18–50 years from the Department of Nephrology, Karolinska University Hospital Solna, Stockholm, Sweden, were recruited from December 2012 to December 2013 and divided into five groups according to their stage of renal impairment (CKD 1–CKD 5). Staging of CKD was defined according to the presence or absence of kidney damage and level of kidney function, irrespective of the type of kidney disease (diagnosis) (National Kidney, 2002), according to Table 1. CKD stage was further based on creatinine–cystatin C equation for estimated glomerular filtration rate (eGFR) (Inker et al., 2012). Of the 101 men questioned, 66 volunteered to provide semen samples and fasting blood sample. In Table 1, study characteristics of the participants are included. The time between blood test and semen sample did not exceed 2 weeks for any of the participants. No participants were included, if they were smoker or former smokers (>3 months), had type 1 or type 2 diabetes mellitus, had a previous renal transplantation, were treated with testosterone replacement therapy, had already known infertility and/or had sexual abstinence
