Erectile Function Decline in Men with Chronic Kidney Disease: A Three-Year Case-Control Study Comparing...

Background/Objectives: Sexual dysfunction is highly prevalent in men with chronic kidney disease (CKD), but longitudinal data across the CKD spectrum, particularly those directly comparing non-dialysis CKD with haemodialysis, are limited. We aimed to characterise longitudinal patterns in erectile and broader sexual function over three years, focusing on persistent between-group stratification and change over time in men with CKD versus community controls, and to identify clinical predictors of poorer outcomes. Methods: We conducted a three-year prospective cohort study in three groups of adult men: a group on haemodialysis, a group with non-dialysis CKD stages 3A/3B, and age-matched community controls without known kidney disease. The primary endpoint was the erectile function (EF) domain score of the International Index of Erectile Function (IIEF-15), assessed annually; the IIEF-15 total score and remaining domains were the secondary outcomes. Participants' health-related quality of life (EQ-5D-5L), age, and diabetes status were recorded. Linear mixed effects models with participant-level random intercepts estimated the effects of group, year, and group × year, adjusted for age, EQ-5D-5L, and diabetes. Results: We enrolled 267 men (haemodialysis n = 96; CKD n = 88; and controls n = 83). At every time point, EF and other IIEF-15 domain scores showed a graded pattern with controls being the highest, CKD being intermediate, and haemodialysis the lowest. group × year interactions were not significant, indicating parallel trajectories without differential decline between groups over three years. Having a lower EQ-5D-5L, an older age, and diabetes-particularly type 2-were independent predictors of poorer IIEF-15 scores across domains. Conclusions: Male sexual function in CKD is persistently and gradually impaired along the renal disease spectrum, with patients on haemodialysis faring the worst and with no evidence of divergent longitudinal change. Routine EF screening, systematic attention to patients' quality of life, and aggressive management of diabetes should be embedded in CKD care pathways, and renal-appropriate erectile dysfunction interventions should be considered earlier and more systematically.