title: Prevalence and correlates of self-reported sexual dysfunction in CKD: a meta-analysis of observational studies.
abstract: BACKGROUND
  Sexual dysfunction is an under-recognized problem in men and women with chronic kidney disease (CKD). The prevalence, correlates, and predictors of this condition in patients with CKD have not been evaluated comprehensively.
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  Patients treated using dialysis (dialysis patients), patients treated using transplant (transplant recipients), and patients with CKD not treated using dialysis or transplant (nondialysis nontransplant patients with CKD).
  
  
  METHODS
  Observational studies conducted in patients with CKD only or including a control group without CKD.
  
  
  METHODS
  Type of study population.
  
  
  RESULTS
  Sexual dysfunction in men and women with CKD using validated tools, such as the International Index of Erectile Function, the Female Sexual Function Index (FSFI), or other measures as reported by study investigators.
  
  
  RESULTS
  50 studies (8,343 patients) of variable size (range, 16-1,023 patients) were included in this review. Almost all studies explored sexual dysfunction in men and specifically erectile dysfunction. The summary estimate of erectile dysfunction in men with CKD was 70% (95% CI, 62%-77%; 21 studies, 4,389 patients). Differences in reported prevalence rates of erectile dysfunction between different studies were attributable primarily to age, study populations, and type of study tool used to assess the presence of erectile dysfunction. In women, the reported prevalence of sexual dysfunction was assessed in only 306 patients from 2 studies and ranged from 30%-80%. Compared with the general population, women with CKD had a significantly lower overall FSFI score (8 studies or subgroups, 407 patients; mean difference, -9.28; 95% CI, -12.92 to -5.64). Increasing age, diabetes mellitus, and depression consistently were found to correlate with sexual dysfunction in 20 individual studies of patients with CKD using different methods.
  
  
  CONCLUSIONS
  Suboptimal and lack of uniform assessment of outcome measures.
  
  
  CONCLUSIONS
  Sexual dysfunction is highly prevalent in both men and women with CKD, especially among those on dialysis. Larger studies enrolling different ethnic groups, using validated study tools, and analyzing the influence of various factors on the development of sexual dysfunction are needed.
authors.affiliation: Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Sankar D
authors.initials: SD
authors.lastname: Navaneethan
authors.forename: Mariacristina
authors.initials: M
authors.lastname: Vecchio
authors.forename: David W
authors.initials: DW
authors.lastname: Johnson
authors.forename: Valeria
authors.initials: V
authors.lastname: Saglimbene
authors.forename: Giusi
authors.initials: G
authors.lastname: Graziano
authors.forename: Fabio
authors.initials: F
authors.lastname: Pellegrini
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lucisano
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Craig
authors.forename: Marinella
authors.initials: M
authors.lastname: Ruospo
authors.forename: Giorgio
authors.initials: G
authors.lastname: Gentile
authors.forename: Valeria Maria
authors.initials: VM
authors.lastname: Manfreda
authors.forename: Marialuisa
authors.initials: M
authors.lastname: Querques
authors.forename: Paul
authors.initials: P
authors.lastname: Stroumza
authors.forename: Marietta
authors.initials: M
authors.lastname: Torok
authors.forename: Eduardo
authors.initials: E
authors.lastname: Celia
authors.forename: Ruben
authors.initials: R
authors.lastname: Gelfman
authors.forename: Juan Nin
authors.initials: JN
authors.lastname: Ferrari
authors.forename: Anna
authors.initials: A
authors.lastname: Bednarek-Skublewska
authors.forename: Jan
authors.initials: J
authors.lastname: Dulawa
authors.forename: Carmen
authors.initials: C
authors.lastname: Bonifati
authors.forename: Jörgen
authors.initials: J
authors.lastname: Hegbrant
authors.forename: Charlotta
authors.initials: C
authors.lastname: Wollheim
authors.forename: Emmanuele A
authors.initials: EA
authors.lastname: Jannini
authors.forename: Giovanni F M
authors.initials: GF
authors.lastname: Strippoli
mesh_terms: D015897:Comorbidity; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D016030:Kidney Transplantation; D008297:Male; D015995:Prevalence; D011379:Prognosis; D011788:Quality of Life; D006435:Renal Dialysis; D018570:Risk Assessment; D017678:Sex Distribution; D012735:Sexual Dysfunction, Physiological / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D020018:Sexual Dysfunctions, Psychological / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy