Erectile dysfunction (ED) is a very frequent, but under-diagnosed and under-studied health problem in men with chronic kidney disease (CKD). ED has been reported in up to 70% of men with CKD, occuring more frequently in dialysis patients (both peritoneal and haemodialysis) compared with CKD patients who were not on dialysis and with kidney transplant recipients. However, few of them received any treatment for ED, what may reflect the reticence of men to discuss sexual issues with their doctors.
Data on the risk factors for ED in patients with CKD and/or chronic heamodialysis have been obtained mainly in small groups of patients with insufficient statistical power, as most of the analyses were not adequately adjusted for confounders. In this context, the recent paper by the Collaborative Depression and Sexual Dysfunction in Haemodialysis Working Group, a cross-sectional study, evaluated 946 men aged 18 years and older, who were representative of men on haemodialysis. ED was assessed using a validated detailed questionnaire. This study evaluated a large number of potential risk factors using multivariable analyses.
In this group, 83% of men reported experiencing ED. Among them, 445 men (47% of the cohort) reported severe erectile problems. However, only 2% of men with severe ED reported use of phosphodiesterase type-5 inhibitor treatment. The risk of ED increased with age, and being married and employed was associated with lower risk of ED. Diabetic nephropathy and hypertensive nephrosclerosis were associated with higher risk of ED compared with other kidney diseases. Greater interdialytic weight gain and co-existent endocrine abnormalities were associated with a significantly higher risk of ED, whereas being on the waiting list for kidney transplant was associated with better sexual function. Importantly, more severe depression was strongly associated with higher prevalence and greater severity of ED.
Thus, ED is a very frequent and neglected problem in men on haemodialysis. Of note, men who declined to participate were older and more likely to be retired. Greater age and lack of professional activity were associated with higher risk of ED. Thus, real prevalence of ED in men on haemodialysis may be higher than that reported in the paper. The results of this study suggest role of generalized microvascular disease due to diabetes, hypertension or hormonal dysregulation in the development of ED. However, the results of this cross-sectional study should be interpreted cautiously. More severe depression was associated with more severe ED; however, these results do not permit to conclude on the causal relationship. Unmarried men on haemodialysis had more severe ED; however, they may have had some erectile problems before CKD developed and therefore, they were less likely to get married.
In conclusion, ED is a frequent problem in men on haemodialysis, but they rarely speak about sexual issues to their doctors. Therefore, clinicians in charge of these patients should address this problem themselves. All the men on haemodialysis, especially those at high risk of ED, should be asked about ED using easily available validated questionnaires.
Reference: Collaborative Depression and Sexual Dysfunction in Haemodialysis Working Group – Prevalence and correlates of erectile dysfunction in men on chronic haemodialysis: a multinational cross-sectional study. Nephrol Dial Transplant, published 2011 Dec 29 online at: http://ndt.oxfordjournals.org/content/early/2011/12/29/ndt.gfr635.long doi: 10.1093/ndt/gfr635.