Prevalence and predictors of erectile dysfunction among hemodialysis patients

Background Erectile dysfunction represents a prevalent yet unrecognized complication in male hemodialysis (HD) patients. Hormonal disturbances, mineral metabolism abnormalities, and psychological stress are potential contributors. The objective of this study was to assess erectile function (EF) in HD patients and examine its association with testosterone levels, biochemical markers, and psychological status. Patients and methods This case–control study enrolled 80 male HD patients and 40 healthy controls matched for age and BMI. Individuals with diabetes or chronic systemic illness were excluded. EF was evaluated using the International Index of Erectile Function (IIEF)-5 questionnaire. Serum testosterone, ionized calcium, phosphorus, intact parathyroid hormone (iPTH), hemoglobin, and dialysis adequacy (Kt/V) were measured. The Hospital Anxiety and Depression Scale was deployed to ascertain anxiety and depression. Moreover, we carried out correlation and multivariate regression analyses. Results HD patients had significantly lower IIEF-5 scores (12.5 ± 4.3 vs. 21.6 ± 3.9, P <0.001) and testosterone levels, along with higher phosphorus and iPTH levels. EF (IIEF-5 score) showed negative correlations with depression ( r =–0.61), anxiety ( r =–0.54), and a positive relation with testosterone ( r =0.62). In multivariate analysis, significant predictors of IIEF-5 score were testosterone (β=0.032, P <0.001), depression (β=–0.41, P <0.001), anxiety (β=–0.28, P =0.001), iPTH (β=–0.008, P =0.006), and age (β=–0.12, P =0.003). Conclusion Erectile dysfunction is prevalent among HD patients and is independently linked to low testosterone, psychological distress, and mineral metabolism disturbances. Therefore, early diagnosis and multidisciplinary management are recommended.