Kolvatzis M. et al., 2025: Erectile Dysfunction in Chronic Kidney Disease and Hemodialysis Patients: A State-of-the-Art Review.
Merkourios Kolvatzis 1, Apostolos Apostolidis 1, Fotios Dimitriadis 2, Konstantinos Hatzimouratidis 1, Kyriakos Moysidis 1
12nd Department of Urology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, GRC.
21st Department of Urology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, GRC.
Abstract
Erectile dysfunction (ED) is a prevalent condition that significantly impacts the quality of life and overall well-being of affected individuals. This state-of-the-art (SotA) review covers literature published between 2020 and 2024, focusing on adult patients with chronic kidney disease (CKD) at various stages, including those receiving hemodialysis and individuals who have undergone renal transplantation. The pathophysiology of ED in CKD patients is multifaceted, involving vascular, neurogenic, hormonal, and psychological components that are further exacerbated by the metabolic and hemodynamic alterations associated with kidney disease. The review provides a comprehensive analysis of current diagnostic approaches, including clinical assessment tools, laboratory evaluations, and imaging modalities that aid in identifying the underlying causes of ED in CKD patients. Pharmacological treatments, particularly phosphodiesterase type 5 (PDE5) inhibitors, remain the cornerstone of therapy; however, their efficacy and safety in patients with renal impairment require careful consideration. Non-pharmacological interventions, such as lifestyle modifications, exercise regimens, and psychological support, are explored as integral components of a holistic management approach. Additionally, advanced therapeutic options, including intracavernosal injections, vacuum erection devices, penile prostheses, and emerging therapies such as low-intensity shockwave therapy, stem cell treatment, and gene therapy, are critically reviewed in the context of CKD. This review also examines the bidirectional relationship between ED and comorbidities commonly associated with CKD, including cardiovascular disease, diabetes mellitus, and metabolic syndrome. Special emphasis is placed on the impact of dialysis modalities and renal transplantation on erectile function, highlighting the challenges in managing ED in these specific patient populations. Moreover, the psychological burden of ED, coupled with the stigma associated with CKD and sexual health, underscores the necessity of a multidisciplinary approach that integrates nephrologists, urologists, psychologists, and primary care providers. Despite advancements in treatment modalities, challenges such as limited patient adherence, stigma, and disparities in healthcare access persist. Addressing these issues requires targeted educational initiatives and policy changes to enhance patient awareness and access to comprehensive care.
Cureus. 2025 Feb 19;17(2):e79292. doi: 10.7759/cureus.79292. eCollection 2025 Feb.
PMID: 40125220
Comments 1
This comprehensive review explores the high prevalence of erectile dysfunction (ED) among patients with chronic kidney disease (CKD) and those undergoing hemodialysis. It delves into the multifaceted causes, diagnostic challenges, and treatment options, emphasizing the profound impact of ED on patients' quality of life.
Key Findings
Prevalence: ED is notably common in CKD and hemodialysis patients, with reported rates ranging from 47.6% to 80%.
Contributing Factors: The development of ED in these populations is attributed to a combination of physiological, psychological, and treatment-related factors, including hormonal imbalances, vascular issues, and the psychological burden of chronic illness.
Diagnostic Challenges: Diagnosing ED in CKD patients is complex due to overlapping symptoms and the influence of multiple comorbidities.
Treatment Approaches: Management strategies encompass pharmacological interventions, such as phosphodiesterase type 5 inhibitors, as well as addressing underlying CKD-related factors.
Specifically, the authors highlight a study that evaluated the efficacy of low-intensity ESWT (Li-ESWT) in improving erectile function among CKD patients.
Lucio Dell’Atti, Current treatment options for erectile dysfunction in kidney transplant recipients, Sexual Medicine Reviews, Volume 12, Issue 3, July 2024, Pages 442–448, https://doi.org/10.1093/sxmrev/qeae028
The study found that Li-ESWT led to significant improvements in International Index of Erectile Function (IIEF) scores, suggesting that this non-invasive therapy could be a promising option for managing ED in this patient population. The inclusion of this reference underscores the potential of ESWT as an emerging treatment modality for ED in CKD patients, particularly for those who may not respond well to conventional therapies like phosphodiesterase type 5 inhibitors.
Conclusion
ED is a prevalent and multifactorial complication in CKD and hemodialysis patients. A multidisciplinary approach is essential for effective diagnosis and management, aiming to improve both sexual health and overall well-being in this patient population
Jens Rassweiler