Treatment options for sexual dysfunction in patients with chronic kidney disease: a systematic review of randomized controlled trials.
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.
Vecchio
Mariacristina
M
Department of Clinical Pharmacology and Epidemiology, Mario Negri Sud Consortium, S Maria Imbaro, Italy.
Navaneethan
Sankar D
SD
Johnson
David W
DW
Lucisano
Giuseppe
G
Graziano
Giusi
G
Querques
Marialuisa
M
Saglimbene
Valeria
V
Ruospo
Marinella
M
Bonifati
Carmen
C
Jannini
Emmanuele A
EA
Strippoli
Giovanni F M
GF
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
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