https://doi.org/10.4081/aiua.2025.13856
Exploring the association between hemoglobin, hematocrit, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio with erectile dysfunction in chronic kidney disease patients undergoing hemodialysis: a cross-sectional study
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: 30 June 2025
Erectile dysfunction (ED) is one of the complications in male patients with end-stage chronic kidney disease (CKD). Renal replacement therapy may improve general conditions and thus improve erectile function. This study aims to determine changes in erectile dysfunction in end-stage CKD patients who underwent hemodialysis, focusing on changes in laboratory parameters. This cross-sectional study was conducted from March to April 2024 at the Hemodialysis Unit of Wangaya General Hospital. The subjects were male patients with end-stage chronic kidney disease (CKD) who were undergoing hemodialysis and met the specific inclusion and exclusion criteria. Erectile function was assessed using the International Index of Erectile Function (IIEF- 5) and the Erection Hardness Score (EHS). Laboratory parameters, including hemoglobin, hematocrit, neutrophil count, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) were recorded. Twenty-two subjects were included in this study. The prevalence of ED before starting hemodialysis and after a period of at least 3 months of hemodialysis was 28.3% and 86.4% respectively. A statistically significant difference was observed in the IIEF-5 scores of patients before and after hemodialysis (p=0.001). Significant differences were observed in the erection degree before and after hemodialysis based on IIEF-5 (p=0.001) and EHS (p=0.001). There was a significant correlation between erection degree assessed by IIEF-5 and hemoglobin, hematocrit, NLR and PLR; and erection degree assessed by EHS and hemoglobin, hematocrit, and PLR, (all p<0.05). In conclusion, there is a deterioration in erectile function in patients undergoing hemodialysis compared to their condition before hemodialysis. There was a significant correlation between hemoglobin, hematocrit, NLR, and PLR and erectile dysfunction.
Downloads
Warli SM, Alamsyah MT, Nasution AT, et al. The assessment of male erectile dysfunction characteristics in patients undergoing continuous ambulatory peritoneal dialysis and hemodialysis using the international index of erectile function (IIEF-5) combined with hospital anxiety and depression scales. Int J Nephrol Renovasc Dis. 2023; 16:155-61. DOI: https://doi.org/10.2147/IJNRD.S402540
Muneer A, Kalsi J, Nazareth I, Arya M. Erectile dysfunction. BMJ. 2014;27;348. DOI: https://doi.org/10.1136/bmj.g129
NIH Consensus Conference. Impotence. NIH Consensus Development Panel on Impotence. JAMA. 1993; 270:83-90. DOI: https://doi.org/10.1001/jama.1993.03510010089036
Chen L, Shi GR, Huang DD, et al. Male sexual dysfunction: A review of literature on its pathological mechanisms, potential risk factors, and herbal drug intervention. Biomed Pharmacother. 2019; 112:108585. DOI: https://doi.org/10.1016/j.biopha.2019.01.046
Gorsane I, Amri N, Younsi F, et al. Erectile dysfunction in hemodialysis patients. Saudi J Kidney Dis Transpl. 2016; 27:23-8. DOI: https://doi.org/10.4103/1319-2442.174057
Edey MM. Male sexual dysfunction and chronic kidney disease. Front Med (Lausanne). 2017; 4:1-10. DOI: https://doi.org/10.3389/fmed.2017.00032
Stolic RV, Bukumiric ZM, Jovanovic AN, et al. Residual renal function and erectile dysfunction in patients on hemodialysis. Int Urol Nephrol. 2012; 44:891-5. DOI: https://doi.org/10.1007/s11255-011-9931-z
Savadi H, Khaki M, Javnbakht M, Pourrafiee H. The impact of hemodialysis on sexual function in male patients using the international index of erectile function questionnaire (IIEF). Electron Physician. 2016; 8:2371-7. DOI: https://doi.org/10.19082/2371
Duarsa GWK, Kandarini Y, Winarta GK, et al. A comparison of erectile dysfunction improvement between patients with regular hemodialysis and patients with continuous ambulatory peritoneal dialysis. J Sex Med. 2021; 18:920-5. DOI: https://doi.org/10.1016/j.jsxm.2021.02.007
El-Assmy A. Erectile dysfunction in hemodialysis: A systematic review. World J Nephrol. 2012; 1:160-5. DOI: https://doi.org/10.5527/wjn.v1.i6.160
Fernandes GV, Dos Santos RR, Soares W, et al. The impact of erectile dysfunction on the quality of life of men undergoing hemodialysis and its association with depression. J Sex Med. 2010; 7:4003-10. DOI: https://doi.org/10.1111/j.1743-6109.2010.01993.x
Ali MEM, Abdel-Hafez HZ, Mahran AM, et al. Erectile dysfunction in chronic renal failure patients undergoing hemodialysis in Egypt. Int J Impot Res. 2005; 17:180-5. DOI: https://doi.org/10.1038/sj.ijir.3901286
Tsai WK, Chiang PK, Chen M, Yang S. Prevalence and correlates of erectile dysfunction among end-stage renal disorder patients on hemodialysis. Hypertension. 2008; 52:49-1.
Neto AF, de Freitas Rodrigues MA, Saraiva Fittipaldi JA, Moreira ED Jr. The epidemiology of erectile dysfunction and its correlates in men with chronic renal failure on hemodialysis in Londrina, southern Brazil. Int J Impot Res. 2002; 14:19-26. DOI: https://doi.org/10.1038/sj.ijir.3900894
Cerqueira J, Moraes M, Glina S. Erectile dysfunction: prevalence and associated variables in patients with chronic renal failure. Int J Impot Res. 2002; 14:65-71. DOI: https://doi.org/10.1038/sj.ijir.3900811
Messina LE, Claro JA, Nardozza A, et al. Erectile dysfunction in patients with chronic renal failure. Int Braz J Urol. 2007; 33:673-8. DOI: https://doi.org/10.1590/S1677-55382007000500008
Sambel M, Kilic M, Demirbas M, et al. Relationship between erectile dysfunction and the neutrophil to lymphocyte and platelet to lymphocyte ratios. Int J Impot Res. 2018; 30:27-35. DOI: https://doi.org/10.1038/s41443-017-0007-1
Aslan A, Kaya Y, Çırakoglu A, et al. Neutrophil-lymphocyte ratio could be a marker for erectile dysfunction. Urol J. 2019; 16:216-20.
Pakpahan C, Ilhamsyah I, Supardi S, et al. The interplay between neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, erectile dysfunction, and Peyronie’s disease: A meta-analysis of observational studies. Arch Ital Urol Androl. 2023;95:11162. DOI: https://doi.org/10.4081/aiua.2023.11162
How to Cite
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.