Chronic kidney disease (CKD) has been associated with erectile dysfunction (ED); however, references regarding the penile hemodynamics in this disease entity are rather limited. In light of the fact that diabetes is a key risk factor for both CKD and ED, this study investigates the penile hemodynamics profile in a large Taiwanese cohort of non-diabetic CKD patients with erectile dysfunction.

Detailed medical records of 617 non-diabetic men with ED between May 2016 and November 2023 were retrospectively reviewed. Patients were stratified by CKD status based on their estimated Glomerular Filtration Rate (eGFR). Erectile function was evaluated using the International Index of Erectile Function-5 (IIEF-5) and the Erection Hardness Score (EHS), while penile Doppler ultrasound (PDU) measured peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI). Multivariate logistic regression analyses were applied to examine the effects of CKD on vasculogenic ED. A P value less than 0.05 was considered significant.

The IIEF-5 scores of advanced non-diabetic CKD groups are significantly lower than mild CKD groups (P < 0.001). PDU showed significantly reduced PSV (P < 0.001) and increased EDV (P = 0.003) in advanced non-diabetic CKD (P < 0.001). Compared with non-CKD group, CKD patients had a higher risk of vasculogenic ED (arterial insufficiency: OR 2.23, P < 0,001; veno-occlusive dysfunction: OR 1.58, P = 0.008). Furthermore, eGFR correlated with relevant hormones, including T3 (r = 0.186, P < 0.001), TSH (r = −0.132, P < 0.001), prolactin (r = −0.089, p = 0.036), and testosterone (r = 0.040, p= 0.336). A correlation between eGFR and PDU parameters was also observed, including PSV (r = 0.156, P < 0.001), EDV (r = −0.153, P < 0.001), and RI (r = 0.187, P < 0.001).

This research identifies chronic kidney disease as a distinct risk factor for erectile dysfunction. In non-diabetic individuals, a decline in renal function is associated with a deterioration in IIEF scores and diminished penile hemodynamics.