The Impact of Renal Replacement Therapy and Kidney Transplantation on Erectile Function and Reproductive Health in Men with Chronic Kidney Disease

Abstract

Introduction: Chronic kidney disease (CKD) is a pressing medical and social problem accompanied by a wide range of complications, including erectile dysfunction (ED) and reproductive health disorders. Objective: To study the effect of renal replacement therapy (RRT) in the form of hemodialysis (HD) and kidney transplantation (KT) on erectile function (EF) and reproductive health of men with CKD. Material and Methods : Prospective observation of 477 male patients (mean age 35.1 ± 2.0 years) with CKD. 201 patients (42.1%) were on program HD, 276 patients (57.9%) underwent KT from a living related donor. The EF was assessed using the IIEF-5 score, doppler sonography of the penile arteries was used to diagnose hemodynamics in the vessels of the penis, the hormonal profile of patients was determined using testosterone, luteinizing hormone, and follicle-stimulating hormone levels, and reproductive function was determined using a spermogram at three stages of the study: initially, high azotemia and 12 months after RRT or KT. Results: In patients after KT, 65.6% of cases of EF were completely restored after one year, the proportion of moderate-mild erectile dysfunction decreased to 9.4%, and the mild form persisted in 25%. The average IIEF-5 score increased from 13.2 ± 0.1 to 21.2 ± 0.2 (p < 0.001), the average peak systolic velocity in the right cavernous arteries increased from 5.6 ± 0.1 to 7.2 ± 0.1 cm/s (p < 0.001), testosterone level—from 4.6 ± 0.1 to 5.6 ± 0.2 ng/ml (p < 0.001), the frequency of normospermia—from 37.3% to 61.2% (p < 0.001). In patients on HD, ED progression was noted with a decrease IIEF-5 score from 21.9 to 9.7 points (p < 0.001). The average peak systolic velocity in the right cavernous arteries decreased from 6.5 ± 0.1 to 4.8 ± 0.1 cm/s (p < 0.001), testosterone level—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), the frequency of normospermia—from 59.2% to 50.7% (p < 0.001), with an increase in cases of pathological disorders of spermatogenesis in total up to 14.0% (p < 0.001). Conclusion: The obtained data indicate effective restoration of EF and fertility in most patients after KT. In patients on HD, there is persistence of multifactorial ED caused by vascular, hormonal and structural changes.