Erectile function and reproductive health in men with chronic kidney disease receiving renal replacement therapy

Introduction. Chronic kidney disease (CKD) is a major medical and public health problem and is accompanied by a broad spectrum of complications, including erectile dysfunction (ED) and disorders of reproductive health, which substantially impair quality of life in affected men and may be further exacerbated by renal replacement therapy (RRT). Objective. To evaluate the impact of hemodialysis as a form of RRT on erectile function and reproductive health in men with CKD. Materials& methods. A prospective study was conducted in 201 male patients with CKD receiving scheduled hemodialysis (mean age 35.2 ± 1.9 years). Erectile function was assessed using the International Index of Erectile Function (IIEF‑5); penile hemodynamics were evaluated by duplex Doppler ultrasonography of the penile arteries; hormonal status was characterized by serum testosterone, luteinizing hormone, and follicle‑stimulating hormone levels; and reproductive function was evaluated by semen analysis and testicular volume at three time points: baseline (severe azotemia) and 12 months after initiation of RRT. ED therapy included phosphodiesterase type‑5 inhibitors (5 mg once daily for 3 months, then 20 mg on demand), targeted pelvic‑floor exercises, vacuum therapy, and physiotherapy. Results. ED progressed over time, with mean IIEF‑5 scores declining from 21.9 to 9.7 points (p < 0.001), and the proportions of patients with mild‑to‑moderate, moderate, and severe ED rising to 20.4%, 65.7%, and 13.9%, respectively. Mean peak systolic velocity in the right cavernosal artery decreased from 6.5 ± 0.1 to 4.8 ± 0.1 cm/s (p < 0.001); serum testosterone from 5.1 ± 0.2 to 4.0 ± 0.2 ng/ml (p < 0.001); luteinizing hormone from 8.9 ± 0.1 to 6.9 ± 0.1 (p < 0.001); follicle‑stimulating hormone from 6.3 ± 0.1 to 5.0 ± 0.1 (p < 0.001); and the prevalence of normozoospermia from 59.2% to 50.7% (p < 0.001), with a concomitant increase in pathological spermatogenesis (asthenozoospermia, oligozoospermia, oligo-astheno-teratozoospermia) to 14.0% (p < 0.001). Conclusions. CKD and hemodialysis are associated with multifactorial impairments of erectile and reproductive function driven by vascular, hormonal, and structural alterations.