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World J Nephrol. Nov 6, 2014; 3(4): 220-229
Published online Nov 6, 2014. doi: 10.5527/wjn.v3.i4.220
Chronic kidney disease and erectile dysfunction
Etsu Suzuki, Hiroaki Nishimatsu, Shigeyoshi Oba, Masao Takahashi, Yukio Homma
Etsu Suzuki, Institute of Medical Science, St. Marianna University School of Medicine, Miyamae-ku, Kawasaki 216-8512, Japan
Hiroaki Nishimatsu, Yukio Homma, The Department of Urology, Faculty of Medicine, University of Tokyo, Bunkyo-ku, Tokyo 113-8655, Japan
Shigeyoshi Oba, Masao Takahashi, The Department of Internal Medicine, Faculty of Medicine, University of Tokyo, Bunkyo-ku, Tokyo 113-8655, Japan
Author contributions: All the authors solely contributed to this paper.
Correspondence to: Etsu Suzuki, MD, PhD, Institute of Medical Science, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki 216-8512, Japan. esuzuki-tky@umin.ac.jp
Telephone: +81-44-9778361 Fax: +81-44-977-8361
Received: May 20, 2014
Revised: June 22, 2014
Accepted: September 6, 2014
Published online: November 6, 2014
Processing time: 171 Days and 3.5 Hours
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: Erectile dysfunction; Chronic kidney disease; Nitric oxide; Phosphodiesterase type 5; Testosterone

Core tip: Erectile dysfunction (ED) is a common condition in chronic kidney disease (CKD) patients. The etiology is multifactorial. Phosphodiesterase type 5 inhibitors are commonly used for the initial treatment. ED has gained attention as an early marker for cardiovascular disease (CVD), which it frequently precedes. Therefore, it is pivotal to examine the presence of ED in CKD patients not only for the improvement of quality of life but also for the prevention of CVD attack. The pathophysiology of erection, which most nephrologists are not familiar with, is also discussed.