Risk Factors and Clinical Outcomes of Erectile Dysfunction Among Kidney Transplant Recipients: A Single-Center Study.

Abstract

Background: Erectile dysfunction (ED) is a common and under-reported complication in kidney transplant recipients. Continued metabolic dysfunction, heart-related comorbidities, long-term dialysis use, immunosuppressive drug use, and psychosocial stressors can decrease sexual function following successful transplantation, which reduces quality of life and increases cardiovascular risk.

Purpose: To determine the prevalence of erectile dysfunction among kidney transplant recipients and to evaluate associated risk factors and their impact on post-transplant clinical outcomes.

Methodology: This Retrospective study was carried out at Department of Urology at the Hayatabad Medical Complex Peshawar.from jan 2020 to june 2020. involved 65 adult male kidney transplant recipients at least six months after transplantation. The International Index of Erectile Function-5 (IIEF-5) was used to group the erectile function. Demographic factors, comorbidities, dialysis vintage, immunosuppressive therapy, lab parameters, and graft functioning were measured. The erectile dysfunction was categorized as an IIEF-5 score of 21 or below. SPSS was used to analyze data with chi-square and independent t-tests (version 24.0). The independent predictors were determined through multivariable logistic regression. The p-value was considered to be statistically significant at a p-value of less than 0.05.

Results: A total of 65 kidney transplant recipients were included, with a mean age of 46.7 ± 8.9 years. Erectile dysfunction was observed in 38 patients (58.5%). Mean IIEF-5 score among patients with ED was 13.9 ± 4.3, compared with 23.5 ± 1.8 in those without ED (p < 0.001). Patients with ED were significantly older than those without ED (50.1 ± 7.6 vs 41.6 ± 7.2 years, p < 0.001). Diabetes mellitus was more frequent in the ED group (63.2% vs 29.6%, p = 0.009), as was hypertension (78.9% vs 51.9%, p = 0.03). Dialysis vintage exceeding 24 months was reported in 57.9% of ED patients compared with 29.6% in non-ED patients (p = 0.02). Mean estimated glomerular filtration rate was lower among patients with ED (53.8 ± 11.9 vs 62.7 ± 10.3 mL/min/1.73m², p = 0.01). On multivariable analysis, age ≥45 years (AOR = 3.08; 95% CI 1.11–8.52), diabetes mellitus (AOR = 2.94; 95% CI 1.02–8.45), and dialysis vintage >24 months (AOR = 2.61; 95% CI 1.01–6.74) remained independent predictors of erectile dysfunction.

Conclusion: Erectile dysfunction is a disease experienced by over half of patients undergoing kidney transplants, which is independently related to older age, diabetes mellitus, extensive exposure to dialysis, and poor graft functioning. Since it has a high correlation with cardiovascular risk and quality of life deficit, regular screening of the ED with validated tools ought to be included in post-transplant care to allow the early identification of this phenomenon and multidisciplinary care.