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Review
. 2014 Nov 6;3(4):220-9.
doi: 10.5527/wjn.v3.i4.220.

Chronic kidney disease and erectile dysfunction

Etsu Suzuki  1 , Hiroaki Nishimatsu  1 , Shigeyoshi Oba  1 , Masao Takahashi  1 , Yukio Homma  1
Affiliations
Review

Chronic kidney disease and erectile dysfunction

Etsu Suzuki et al. World J Nephrol. .

Abstract

Erectile dysfunction (ED) is a common condition among male chronic kidney disease (CKD) patients. Its prevalence is estimated to be approximately 80% among these patients. It has been well established that the production of nitric oxide from the cavernous nerve and vascular endothelium and the subsequent production of cyclic GMP are critically important in initiating and maintaining erection. Factors affecting these pathways can induce ED. The etiology of ED in CKD patients is multifactorial. Factors including abnormalities in gonadal-pituitary system, disturbance in autonomic nervous system, endothelial dysfunction, anemia (and erythropoietin deficiency), secondary hyperparathyroidism, drugs, zinc deficiency, and psychological problems are implicated in the occurrence of ED. An improvement of general conditions is the first step of treatment. Sufficient dialysis and adequate nutritional intake are necessary. In addition, control of anemia and secondary hyperparathyroidism is required. Changes of drugs that potentially affect erectile function may be necessary. Further, zinc supplementation may be necessary when zinc deficiency is suspected. Phosphodiesterase type 5 inhibitors (PDE5Is) are commonly used for treating ED in CKD patients, and their efficacy was confirmed by many studies. Testosterone replacement therapy in addition to PDE5Is may be useful, particularly for CKD patients with hypogonadism. Renal transplantation may restore erectile function. ED is an early marker of cardiovascular disease (CVD), which it frequently precedes; therefore, it is crucial to examine the presence of ED in CKD patients not only for the improvement of the quality of life but also for the prevention of CVD attack.

Keywords: Chronic kidney disease; Erectile dysfunction; Nitric oxide; Phosphodiesterase type 5; Testosterone.

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Figures

Figure 1
Figure 1
Nitric oxide is critically implicated in the initiation and maintenance of penile erection. NO: Nitric oxide; eNOS: Endothelial nitric oxide synthase.
See this image and copyright information in PMC

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