End-stage renal disease (ESRD) is associated with a multitude of physical, psychological, and social health challenges, including a profound impact on sexual and reproductive health. Among males with ESRD, erectile dysfunction (ED) is highly prevalent due to factors such as underlying comorbidities, including diabetes and hypertension, and the physiological effects of long-term dialysis. Kidney transplantation (KTx) has been proposed as a potential intervention to mitigate the effects of ED by restoring renal function and improving hormonal balance. However, the evidence surrounding the effectiveness of KTx in improving sexual function, specifically erectile function (EF), remains inconclusive. This systematic review and meta-analysis aim to evaluate the effects of KTx on sexual dysfunction (SexDys), particularly ED, in male ESRD patients.

To evaluate the benefits and potential harms of KTx compared to other forms of renal replacement therapy in improving EF in adult males with ESRD, assessed using the international index of EF (IIEF), to survey the prevalence of SexDys in this population, and to assess the correlation between various factors and SexDys through regression analysis.

A systematic search of PubMed, EMBASE, Cochrane Library, Scopus, ClinicalTrials.gov, and Google Scholar was conducted, following the PRISMA 2020 guidelines. Prospective and retrospective cohort studies, as well as cross-sectional studies assessing EF pre- and post-transplantation, were included. These studies used validated tools such as the IIEF to measure EF. Meta-analyses were performed using a random-effects model to estimate standardized mean differences (SMD) and hazard ratios (HR) with 95% confidence intervals (CI). Heterogeneity was assessed using the I² statistic, and publication bias was evaluated with a funnel plot and the Egger’s test.

A total of 2419 studies were identified, with 362 abstracts screened and 193 full-text articles reviewed. Ultimately, 11 studies were included for qualitative analysis and 7 for quantitative synthesis. The random effects model for SMD yielded a combined estimate of 0.43 (95%CI: -0.20-1.07), indicating a small but non-significant improvement in EF post-transplantation. The heterogeneity across studies was substantial (I² = 90%), reflecting significant variability in outcomes. Subgroup analysis showed greater improvements in EF among living-donor transplant recipients compared to those receiving organs from deceased donors. Despite this trend, the overall result for changes in EF was not statistically significant (P = 0.15). Additionally, the combined HR from the meta-analysis was 2.87 (95%CI: 1.76-4.69), suggesting that KTx significantly increases the likelihood of improved EF, though variability between studies persisted (I² = 63%).

While KTx offers some promise for improving EF in male ESRD patients, the overall evidence remains inconclusive due to high heterogeneity between studies and a lack of statistical significance in the combined results. Despite this, individual studies suggest that KTx may lead to significant improvements in EF for certain subgroups, particularly living-donor recipients. Future research should focus on larger, well-designed cohort studies with standardized outcome measures to provide more definitive conclusions. Addressing SexDys as part of routine care for ESRD patients undergoing KTx is crucial to improving their overall quality of life. However, adjunct therapies such as phosphodiesterase type 5 inhibitors may be necessary for those who do not experience adequate improvements post-transplantation.

• Kidney transplantation
• Sexual dysfunction
• Erectile dysfunction
• International index of erectile function
• Systematic review
• Meta analyses

• kidney transplantation
• patient-reported outcomes
• sexual health

• Humans
• Kidney Transplantation
• Male
• Female
• Middle Aged
• Prospective Studies
• Quality of Life
• Kidney Failure, Chronic/surgery
• Sexual Behavior
• Sexual Dysfunction, Physiological/etiology
• Sexual Dysfunction, Physiological/epidemiology
• Follow-Up Studies
• Prognosis
• Adult
• Risk Factors
• Postoperative Complications
• Glomerular Filtration Rate
• Kidney Function Tests
• Graft Survival

• UL1 TR001445 NCATS NIH HHS
• R01 DK120518 NIDDK NIH HHS
• K02 AG076883 NIA NIH HHS
• R01 AG077888 NIA NIH HHS
• R01 AG076834 NIA NIH HHS
• R01 AG055781 NIA NIH HHS
• R01 DK114074 NIDDK NIH HHS
• F32 AG082486 NIA NIH HHS
• KL2 TR001446 NCATS NIH HHS

• Grip strength
• dialysis
• gait function
• severe erectile dysfunction
• timed get up and go test

• Cross-Sectional Studies
• Erectile Dysfunction/etiology
• Gait
• Hand Strength
• Humans
• Male
• Renal Dialysis

• Persea americana
• cyclosporine
• male reproductive hormones
• sperm quality

• erectile dysfunction
• urogenital reproductive disorders

Although renal-transplant-recipients can lead much more comfortable life in comparison to patients on dialysis, they need to face other problems. One of them is lifetime immunosuppressive therapy on daily basis. Immunosuppressive regimen contains usually three different drugs and although each one of them is crucial to keep graft in good condition and to suppress immune response against the transplanted organ, they influence, among the other, reproductive system. In current paper we have observed that immunosuppressive therapy based on tacrolimus significantly affected the hormonal balance of sex hormones in both men and women. It is of great importance, as nowadays infertility is rising problem even in health people, therefore more attention should be paid to choose the best suitable immunosuppressive regiment for recipient in reproductive age.

It is estimated that approximately 20% of couples suffer from infertility worldwide and within renal-transplant recipients, this problem is 10 times more common. An intake of immunosuppressants may lead to hormonal imbalance. The aim of the study was to investigate the influence of tacrolimus-based therapy on the hormonal status of grafted patients. Blood samples were obtained from patients from the Department of Nephrology, Transplantology, and Internal Medicine of Independent Public Clinical Hospital No. 2, Pomeranian Medical University. All 121 patients had stable graft function for over 6 months. The blood plasma concentrations of luteinizing hormone, follicle-stimulating hormone, prolactin, testosterone, estradiol, cortisol were assessed by the electrochemiluminescence method. We observed decreased levels of prolactin (11.9 ng/mL) and cortisol (87.4 μg/mL) in patients under tacrolimus-based therapy. Tacrolimus-based therapy was also associated with increased testosterone and follicle-stimulating hormone in males, 4.04 ng/mL and 6.9 mLU/mL, respectively, and decreased testosterone levels in females, 0.121 ng/mL. We also assessed that immunosuppressive therapy based on tacrolimus is less nephrotoxic in comparison to other regimens. Concluding, tacrolimus-based therapy may influence the hormonal status of transplant recipients in the current study. Results presented here are believed to be helpful for clinicians and patients, especially within the aspect of willingness for biological offspring.

• hormones
• immunosuppressants
• renal transplantation

Patient survival continues to increase with the growing quality of dialysis and management of chronic kidney disease (CKD). As such, chronic therapy must include considerations of quality of life (QOL), and this includes the disproportionate prevalence of sexual dysfunction (SD) in this patient population. This review aims to describe the pathophysiological and the psychosocial causes of SD with regard to renal replacement therapy, particularly hemo- and peritoneal dialysis. The differences in its manifestation in men and women are compared, including hormonal imbalances—and therefore fertility, libido, and sexual satisfaction—the experience of depression and anxiety, and QOL. The impact of comorbidities and the iatrogenic causes of SD are described. This review also presents validated scales for screening and diagnosis of SD in CKD patients and outlines novel therapies and strategies for the effective management of SD. Increased prevalence of CKD invariably increases the number of patients with SD, and it is crucial for health care professional teams to become familiar with the clinical tools used to manage this sensitive and under-quantified field. As a known predictor of QOL, sexual function should become a point of focus in the pursuit of patient-centered care, particularly as we seek to achieve as “normal” a life as possible for individuals who receive dialysis.

• CKD
• Female Sexual Function Index (FSFI)
• International Index of Erectile Function (IIEF)
• dialysis
• erectile dysfunction
• fertility
• quality of life
• renal replacement therapy
• renal transplant
• sexual dysfunction