title: Treatment options for sexual dysfunction in patients with chronic kidney disease: a systematic review of randomized controlled trials.
abstract: OBJECTIVE
  Sexual dysfunction is very common in patients with chronic kidney disease (CKD), but treatment options are limited. The benefits and harms of existing interventions for treatment of sexual dysfunction were assessed in patients with CKD.
  
  
  METHODS
  MEDLINE (1966 to December 2008), EMBASE (1980 to December 2008), and the Cochrane Trial Registry (Issue 4 2008) were searched for parallel and crossover randomized and quasi-randomized trials. Treatment effects were summarized as mean differences (MD) or standardized mean difference (SMD) with 95% confidence intervals (CI) using a random effects model.
  
  
  RESULTS
  Fourteen trials (328 patients) were included. Phosphodiesterase-5 inhibitors (PDE5i) compared with placebo significantly increased the overall International Index of Erectile Function-5 (IIEF-5) score (three trials, 101 patients, MD 1.81, 95% CI 1.51 to 2.10), all of its individual domains, and the complete 15-item IIEF-5 (two trials, 80 patients, MD 10.64, 95% CI 5.32 to 15.96). End-of-treatment testosterone levels were not significantly increased by addition of zinc to dialysate (two trials, 22 patients, SMD 0.19 ng/dl, 95% CI -2.12 to 2.50), but oral zinc improved end-of-treatment testosterone levels. There was no difference in plasma luteinizing and follicle-stimulating hormone level at the end of the study period with zinc therapy.
  
  
  CONCLUSIONS
  PDE5i and zinc are promising interventions for treating sexual dysfunction in CKD. Evidence supporting their routine use in CKD patients is limited. There is an unmet need for studying interventions for male and female sexual dysfunction in CKD considering the significant disease burden.
authors.affiliation: Department of Clinical Pharmacology and Epidemiology, Mario Negri Sud Consortium, S Maria Imbaro, Italy.
authors.forename: Mariacristina
authors.initials: M
authors.lastname: Vecchio
authors.forename: Sankar D
authors.initials: SD
authors.lastname: Navaneethan
authors.forename: David W
authors.initials: DW
authors.lastname: Johnson
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lucisano
authors.forename: Giusi
authors.initials: G
authors.lastname: Graziano
authors.forename: Marialuisa
authors.initials: M
authors.lastname: Querques
authors.forename: Valeria
authors.initials: V
authors.lastname: Saglimbene
authors.forename: Marinella
authors.initials: M
authors.lastname: Ruospo
authors.forename: Carmen
authors.initials: C
authors.lastname: Bonifati
authors.forename: Emmanuele A
authors.initials: EA
authors.lastname: Jannini
authors.forename: Giovanni F M
authors.initials: GF
authors.lastname: Strippoli
mesh_terms: D000284:Administration, Oral; D000328:Adult; D015415:Biomarkers / Q000097:blood; D002908:Chronic Disease; D054706:Cyclic Nucleotide Phosphodiesterases, Type 5 / Q000378:metabolism; D019587:Dietary Supplements / Q000009:adverse effects; D007172:Erectile Dysfunction / Q000188:drug therapy / Q000209:etiology; D019317:Evidence-Based Medicine; D005260:Female; D043373:Follicle Stimulating Hormone, Human / Q000097:blood; D006801:Humans; D007674:Kidney Diseases / Q000150:complications*; D007986:Luteinizing Hormone / Q000097:blood; D008297:Male; D008875:Middle Aged; D058986:Phosphodiesterase 5 Inhibitors; D010726:Phosphodiesterase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012735:Sexual Dysfunction, Physiological / Q000188:drug therapy* / Q000201:enzymology / Q000209:etiology; D013739:Testosterone / Q000097:blood; D016896:Treatment Outcome; D015032:Zinc / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood
chemical_list: D015415:Biomarkers; D043373:Follicle Stimulating Hormone, Human; D058986:Phosphodiesterase 5 Inhibitors; D010726:Phosphodiesterase Inhibitors; D013739:Testosterone; D007986:Luteinizing Hormone; D054706:Cyclic Nucleotide Phosphodiesterases, Type 5; D015032:Zinc