Phosphodiesterase type 5 inhibitor treatment for erectile dysfunction in patients with end-stage renal disease receiving dialysis or after renal transplantation.
BACKGROUND
The phosphodiesterase type 5 (PDE5) inhibitors are generally well tolerated and effective for treating erectile dysfunction (ED), including in patients with significant comorbidity. Because of this benign safety profile, investigators have used PDE5 inhibitors to treat patients with ED and severe renal disease or those who have received renal transplants.


OBJECTIVE
To assess safety and efficacy of PDE5 inhibitors in patients receiving dialysis or renal transplants.


METHODS
Erectile function as assessed by the International Index of Erectile Function (IIEF) and Global Assessment Questions; adverse events (AEs).


METHODS
We reviewed published studies of PDE5 inhibitors in patients receiving dialysis or renal transplants.


RESULTS
In double-blind, placebo-controlled studies in patients receiving dialysis or renal transplants, sildenafil significantly improved erectile function as assessed by the IIEF, and 75-85% of patients reported improved erectile function on Global Assessment Questions; efficacy was more variable in less well-controlled studies. In >260 patients undergoing dialysis who received sildenafil in clinical studies, there were only six reported discontinuations because of AEs (headache [N=3], headache and nausea [N=1], gastrointestinal [N=1], and symptomatic blood pressure decrease [N=1]). In approximately 400 patients with renal transplants who received sildenafil, only three patients discontinued because of AEs. Vardenafil improved IIEF scores of up to 82% of renal transplant recipients in randomized, controlled studies (N=59, total), with no reported discontinuations because of AEs. Limited data also suggest benefit with tadalafil.


CONCLUSIONS
ED is common in patients undergoing renal dialysis or postrenal transplant and substantially affects patient quality of life. Sildenafil and vardenafil appear to be efficacious and well tolerated in patients receiving renal dialysis or transplant.
Molinette General and University Hospital, Torino, Italy.
Fedele
F
Lasaponara
Omid
O
Sedigh
Giovanni
G
Pasquale
Andrea
A
Bosio
Luigi
L
Rolle
Carlo
C
Ceruti
Massimiliano
M
Timpano
Carlo Luigi Augusto
CL
Negro
Matteo
M
Paradiso
Annamaria
A
Abbona
Giuseppe Paolo
GP
Segoloni
Dario
D
Fontana
D000328:Adult; D004311:Double-Blind Method; D007172:Erectile Dysfunction / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000378:metabolism / Q000503:physiopathology* / Q000601:surgery / Q000628:therapy*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D058986:Phosphodiesterase 5 Inhibitors / Q000493:pharmacokinetics / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D006435:Renal Dialysis; D016896:Treatment Outcome
D058986:Phosphodiesterase 5 Inhibitors
Dialysis; Erectile Dysfunction; Kidney; Liver; Phosphodiesterase Type 5 Inhibitor; Safety; Sildenafil; Transplant