USE OF SILDENAFIL (VIAGRA®) FOR ERECTILE DYSFUNCTION IN DIALYSIS PATIENTS – OUR FIRST EXPERIENCE
Abstract
Background. Male patients with end stage renal disease often report erectile dysfunction, which is very common especially in younger males. Impotence is reported to exceed 50% in male chronic renal failure patients, and is present in 65% of such patients undergoing hemodialysis. Numerous etiological factors have been reported as possible cause for sexual dysfunction. Sildenafil (Viagra®), a potent specific inhibitor of cGMP phosphodiesterase, was used in this case study to improve erectile dysfunction in dialysis male patients.
Methods and results. During 12 weeks we treated 4 dialysis patients. 2 patients were treated with peritoneal dialysis and 2 patients were in the program of chronic hemodialysis. All patients were in the program of dialysis for more than 24 months, and reported erectile dysfunction and impotence after they had started with dialysis treatment. Sildenafil was used in the treatment. The dosage schedule for sildenafil was 50mg/ week orally for 2 weeks followed by 100 mg/week for the next 10 weeks if there was no effect on initial dosage. Efficacy of treatment was evaluated by means of the International Index of Erectile Dysfunction. All 4 patients reported no significant effect on initial dose. With higher dose of sildenafil treatment was overwhelmingly successful, with reported prolonged improvement of erectile dysfunction for 42 to 72 hours. Side effects were present only in 1 patient who had severe headaches after higher dose. No patients experienced priapism.
Conclusions. There have been only few reports in the literature on the use of sildenafil in dialysis patients. Our small case study suggests that sildenafil could be successfully and safely used for treatment of erectile dysfunction also in dialysis patients. A large trial would be necessary to confirm the efficacy of the drug for this specific group of patients.
Downloads
References
Boolell M, Allen MJ, Ballard SA et al. Sildenafil: an oral active type 5 cyclic GMP-specific phosphodiesterase inhibitor for the treatment of penile erectile dysfunction. Int J Impot Res 1996; 8: 47–52.
Freemantle N. Valuing the effects of sildenafil in erectile dysfunction. BMJ 2000; 320: 1165–6.
Macdougall IC, Mahon A, Muri A, Sidhu P. Randomized placebo controlled study of sildenafil (Viagra) in peritoneal dialysis patients with erectile dysfunction. Renal Association Meeting. London: Royal College of Physicians, 1999: 318A–318A.
Mohamed EA, MacDowall P, Coward RA. Timing of sildenafil therapy in dialysis patients-lessons following an episode of hypotension. Nephrol Dial Transplant 2000; 15: 926–6.
Grimm RH. Erectile and sexual dysfunction in hypertension. XV Scientific Meeting of American Society of Hypertension, New York 2000. www.hdcn.com/symp/00ash/grimm/grimm1.html
Rosa S, Wasserstein A, Kobrin S, Feldman HI. Preliminary observation of sildenafil treatment for erectile dysfunction in dialysis patients. Am J Kid Diseases 2001; 37: 134–7.
Palmer BF. Sexual dysfunction in uremia. JASN 1999; 10: 1046–66.
Jacques JA, Abraira CL. Quality-of-life issues in hemodialysis: Case studies on the use of sildenafil for erectile dysfunction. Dialysis & Transplantation 1999; 28: 518–24.
Rajfer J, Aronson WJ, Bush PA, Dorey FJ, Ignarro LJ. Nitric oxide as a mediator of relaxation of the corpus cavernosum in response to nonadrenergic, noncholinergic neurotransmission. N Engl J Med 1992; 326: 90–4.
Langtry HD, Markham A. Sildenafil. A review of its use in erectile dysfunction. Drugs 1999; 57: 967–89.
Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The international index of erectile function (IIEF): A multidimensional scale for assessment of erectile dysfunction. Urology 1997; 49: 822–30.
Menchini–Fabris GF, Turchi P, Giorgi PM, Canale D. Diagnosis and treatment of sexual dysfunction in patients affected by chronic renal failure on hemodialysis. Contrib Nephrol 1990; 77: 24–33.
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.