Erectile Dysfunction in Renal Failure and Transplant Patients

Julia V. Fiuk; Nicholas N. Tadros


Transl Androl Urol. 2019;8(2):155-163. 

In This Article

Abstract and Introduction


Erectile dysfunction (ED) is a prevalent and pertinent condition in the chronic kidney disease (CKD) population. It has a multifactorial etiology, including disruptions of the hypothalamic-pituitary-gonadal axis, the endothelial paracrine signaling system, calcium and vitamin D homeostasis, along with several other factors. Efficacy of treatment of ED in the CKD population is comparable to non-CKD patients across multiple modalities, including PDE5 inhibitors, vacuum erectile devices, intracavernosal injections and penile prostheses. Renal transplant improves the contributing comorbid conditions that lead to ED in CKD patients; thus rates of ED are improved post-transplant. It is important to note that there is a small percentage of patients with persistent ED after renal transplantation.


Erectile dysfunction (ED), defined as an inability to obtain or maintain an erection adequate for satisfactory sexual function, is present in up to 50–80% of patients with chronic kidney disease (CKD).[1] The etiology of ED in this population is multifactorial, with abnormalities in the hypothalamic-pituitary-gonadal axis, autonomic nervous system disturbances, peripheral neuropathy, endothelial dysfunction, anemia, secondary hyperparathyroidism, medication effects and psychological factors such as stress and depression contributing to various degrees.[2,3] Presence of diabetes mellitus and duration of CKD have been shown to be predisposing factors for ED in the CKD population as well.[4] Here we review the pathophysiology of ED in the CKD population, discuss efficacy of various ED treatments, and explore the effect of renal transplant on ED.