Erectile dysfunction in chronic peritoneal dialysis patients: Incidence and treatment with sildenafil

Objectives: Sexual and erectile dysfunction (ED) have been reported to occu r frequently in male patients with end-stage renal disease maintained on di alysis. Numerous etiologies for this ED have been suggested. Although a var iety of therapies for the ED of the dialysis patient have been suggested, m ost clinicians indicate that patients report a poor response to therapy. Re cently, sildenafil has been reported to be beneficial in treating patients with ED of both organic and psychogenic causes. The present study was desig ned to document the incidence of ED in male patients maintained on chronic peritoneal dialysis (CPD) and to determine the efficacy of prescribing sild enafil therapy to treat their ED. Methods: All male patients in our CPD unit were notified by letter of the a vailability of sildenafil as a treatment modality for ED. A sexuality/erect ile dysfunction assessment was conducted in all male patients by their prim ary nephrologist. Patients who reported ED and who had no medical contraind ication to sildenafil were offered this therapy. Those patients who were in terested in this treatment were interviewed by a social worker, and patient s were asked to complete the International Index of Erectile Function quest ionnaire. Sildenafil was prescribed at a starting dose of 25 mg and increas ed to a maximum of 100 mg during a 12-week study trial. Patients were reeva luated 6 and 12 weeks after the start of therapy. * Results: There were 68 male patients maintained on CPD at the time of the s tudy. Mean age of all patients was 60.8 +/- 15.3 years and mean duration on PD was 32.6 +/- 25.6 months. Thirty-three patients had diabetes, 66 hypert ension, 35 peripheral vascular disease, and 32 coronary artery disease. Thi rty-two of 68 male patients in the CPD unit were assessed to have ED. Only 17 of the 32 patients expressed interest in pursuing sildenafil therapy. Tw o of these patients were excluded because they were receiving nitrate thera py. Of the 15 patients who agreed to take sildenafil, only 6 completed the 12-week study. Two of these patients responded to sildenafil. Conclusion: Erectile dysfunction is common in male patients maintained on C PD. Only about half of patients with ED in the present study were willing t o consider sildenafil therapy to treat the ED and, of those who agreed to t reatment, only a minority completed the 12-week trial; 2 of these 6 patient s reported a satisfactory response.