Prevalence and Correlates of Self-Reported Sexual Dysfunction in CKD: A Meta-analysis of Observational Studies

Navaneethan, Sankar D.; Vecchio, Mariacristina; Johnson, David W.; Saglimbene, Valeria; Graziano, Giusi; Pellegrini, Fabio; Lucisano, Giuseppe; Craig, Jonathan C.; Ruospo, Marinella; Gentile, Giorgio; Manfreda, Valeria Maria; Querques, Marialuisa; Stroumza, Paul; Torok, Marietta; Celia, Eduardo; Gelfman, Ruben; Ferrari, Juan Nin; Bednarek-Skublewska, Anna; Dulawa, Jan; Bonifati, Carmen; Hegbrant, Jörgen; Wollheim, Charlotta; Jannini, Emmanuele A.; Strippoli, Giovanni F.M.

doi:10.1053/j.ajkd.2010.06.016

« Previous Next »American Journal of Kidney Diseases
Volume 56, Issue 4 , Pages 670-685, October 2010

Prevalence and Correlates of Self-Reported Sexual Dysfunction in CKD: A Meta-analysis of Observational Studies

Sankar D. Navaneethan, MD, MPH
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
- Cochrane Renal Group, Sydney, Australia
- Sankar D. Navaneethan, MD, MPH, Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
Mariacristina Vecchio, MSc, Pharm Chem
- Department of Clinical Pharmacology and Epidemiology, Mario Negri Sud Consortium, S Maria Imbaro (Ch), Italy
David W. Johnson, MD, PhD
- Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
Valeria Saglimbene, MSc, Pharm Chem
- Department of Clinical Pharmacology and Epidemiology, Mario Negri Sud Consortium, S Maria Imbaro (Ch), Italy
Giusi Graziano, MSc
- Department of Clinical Pharmacology and Epidemiology, Mario Negri Sud Consortium, S Maria Imbaro (Ch), Italy
Fabio Pellegrini, MSc
- Department of Clinical Pharmacology and Epidemiology, Mario Negri Sud Consortium, S Maria Imbaro (Ch), Italy
- Unit of Biostatistics, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (Fg); S.C. di Nefrologia e Dialisi, Ospedale Santa Maria della Misericordia, Perugia, Italy
Giuseppe Lucisano, MSc
- Department of Clinical Pharmacology and Epidemiology, Mario Negri Sud Consortium, S Maria Imbaro (Ch), Italy
Jonathan C. Craig, MBChB, PhD
- Cochrane Renal Group, Sydney, Australia
- Centre for Kidney Research, NHMRC Centre for Clinical Research Excellence in Renal Medicine, School of Public Health, University of Sydney, Sydney, Australia
Marinella Ruospo, MSc, Mol Biol, MD
- Department of Clinical Pharmacology and Epidemiology, Mario Negri Sud Consortium, S Maria Imbaro (Ch), Italy
Giorgio Gentile, MD
- Department of Clinical Pharmacology and Epidemiology, Mario Negri Sud Consortium, S Maria Imbaro (Ch), Italy
- Diaverum Medical-Scientific Office, Lund, Sweden
- Department of Internal Medicine, University of Perugia, Italy
Valeria Maria Manfreda, MD
- Ospedale A. Perrino, Brindisi, Italy
Marialuisa Querques, MD
- Nephrology, University of Milan, San Raffaele, Milan, Italy
Paul Stroumza, MD
- Diaverum Medical-Scientific Office, Lund, Sweden
Marietta Torok, MD
- Diaverum Medical-Scientific Office, Lund, Sweden
Eduardo Celia, MD
- Diaverum Medical-Scientific Office, Lund, Sweden
Ruben Gelfman, MD
- Diaverum Medical-Scientific Office, Lund, Sweden
Juan Nin Ferrari, MD
- Diaverum Medical-Scientific Office, Lund, Sweden
Anna Bednarek-Skublewska, MD, PhD
- Diaverum Medical-Scientific Office, Lund, Sweden
- Department of Nephrology, Medical University School of Lublin, Poland
Jan Dulawa, MD, PhD
- Diaverum Medical-Scientific Office, Lund, Sweden
- Department of Internal Medicine and Metabolic Diseases, Medical University of Silesia, Poland
Carmen Bonifati, MD
- Diaverum Medical-Scientific Office, Lund, Sweden
Jörgen Hegbrant, MD, PhD
- Diaverum Medical-Scientific Office, Lund, Sweden
Charlotta Wollheim, MSc
- Diaverum Medical-Scientific Office, Lund, Sweden
Emmanuele A. Jannini, MD
- School of Sexology, Department of Experimental Medicine, University of L'Aquila, L'Aquila, Italy
Giovanni F.M. Strippoli, MD, PhD, MM, MPH
- Cochrane Renal Group, Sydney, Australia
- Department of Clinical Pharmacology and Epidemiology, Mario Negri Sud Consortium, S Maria Imbaro (Ch), Italy
- Centre for Kidney Research, NHMRC Centre for Clinical Research Excellence in Renal Medicine, School of Public Health, University of Sydney, Sydney, Australia
- Diaverum Medical-Scientific Office, Lund, Sweden
- Address correspondence to Giovanni F.M. Strippoli, MD, PhD, MM, MPH, Mario Negri Sud Consortium, Italy; School of Public Health, University of Sydney, Australia; Diaverum Medical Scientific Office

Received 11 January 2010; accepted 22 June 2010. published online 01 September 2010.

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.

Study Design

Systematic review and meta-analysis.

Setting & Population

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).

Selection Criteria for Studies

Observational studies conducted in patients with CKD only or including a control group without CKD.

Predictor

Type of study population.

Outcomes

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.

Limitations

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.

Index Words: Sexual dysfunction, erectile dysfunction, chronic kidney disease