Sexual dysfunction in chronic renal failure

Recent studies have shown that testosterone is involved in the pathogenesis of cardiovascular diseases. Moreover, in observational studies blood testosterone concentrations, resulted consistently lower, not only among men with cardiovascular disease but also in men with uremia. In order to correlate the blood level of testosterone with the degree of erectile dysfunction (ED) and chronic renal failure (CRF) (stage I-V) we selected a group of patients with renal failure on conservative treatment, who attended our nephrology outpatients clinic. All the patients had stage II and III renal failure, respectively with a creatinine clearance between 59-30 and 29-15 ml/m'. The sexual evaluation was done using a 15-item questionnaire, i.e. the International Index of Erectile Function (IIEF). Mean score of patients with ED were significantly lower than mean scores for healthy controls for all 15 questions (all p values <0.01). Preliminary results show a direct correlation between -IIEF and glomerular filtration rate (GFR) (R2 0.08); an inverse correlation between testosterone and cholesterol (R2 0.045); a higher number of diabetic patients with lower levels of testosterone, at level 3 of CRF; low levels of testosterone for smokers especially in stage II (GFR). These data confirm the direct correlation between ED and renal failure, and the role of diabetes and smoking in hypotestosteronemia, in patients with different degrees of renal insufficiency. Further prospective studies are needed in order to correlate cardiovascular morbidity and mortality in patients with CRF and blood levels of testosterone.