Molinette General and University Hospital, Torino, Italy.
J Sex Med. 2013 Nov;10(11):2798-814. doi: 10.1111/jsm.12038. Epub 2013 Jan 24.
The phosphodiesterase type 5 (PDE5) inhibitors are generally well tolerated and effective for treating erectile dysfunction (ED), including in patients with significant comorbidity. Because of this benign safety profile, investigators have used PDE5 inhibitors to treat patients with ED and severe renal disease or those who have received renal transplants.
To assess safety and efficacy of PDE5 inhibitors in patients receiving dialysis or renal transplants.
Erectile function as assessed by the International Index of Erectile Function (IIEF) and Global Assessment Questions; adverse events (AEs).
We reviewed published studies of PDE5 inhibitors in patients receiving dialysis or renal transplants.
In double-blind, placebo-controlled studies in patients receiving dialysis or renal transplants, sildenafil significantly improved erectile function as assessed by the IIEF, and 75-85% of patients reported improved erectile function on Global Assessment Questions; efficacy was more variable in less well-controlled studies. In >260 patients undergoing dialysis who received sildenafil in clinical studies, there were only six reported discontinuations because of AEs (headache [N=3], headache and nausea [N=1], gastrointestinal [N=1], and symptomatic blood pressure decrease [N=1]). In approximately 400 patients with renal transplants who received sildenafil, only three patients discontinued because of AEs. Vardenafil improved IIEF scores of up to 82% of renal transplant recipients in randomized, controlled studies (N=59, total), with no reported discontinuations because of AEs. Limited data also suggest benefit with tadalafil.
ED is common in patients undergoing renal dialysis or postrenal transplant and substantially affects patient quality of life. Sildenafil and vardenafil appear to be efficacious and well tolerated in patients receiving renal dialysis or transplant.
磷酸二酯酶 5 型（PDE5）抑制剂通常具有良好的耐受性，对治疗勃起功能障碍（ED）有效，包括对合并症较多的患者。由于这种良性的安全性特征，研究人员已将 PDE5 抑制剂用于治疗 ED 合并严重肾脏疾病或接受过肾移植的患者。
评估 PDE5 抑制剂在接受透析或肾移植患者中的安全性和疗效。
国际勃起功能指数（IIEF）和全球评估问题评估的勃起功能；不良事件（AE）。
我们回顾了已发表的 PDE5 抑制剂在接受透析或肾移植患者中的研究。
在接受透析或肾移植患者的双盲、安慰剂对照研究中，西地那非显著改善了 IIEF 评估的勃起功能，75%-85%的患者在全球评估问题中报告勃起功能改善；在控制较差的研究中，疗效变化较大。在接受临床研究的 260 多名接受透析的患者中，仅有 6 例因 AE（头痛[3 例]、头痛和恶心[1 例]、胃肠道[1 例]和症状性血压下降[1 例]）而停药。在大约 400 名接受肾移植的患者中，仅 3 例因 AE 停药。在随机对照研究（共 59 例）中，伐地那非使高达 82%的肾移植受者的 IIEF 评分得到改善，无因 AE 而停药的报告。有限的数据也表明他达拉非有益。
ED 在接受肾透析或肾移植后的患者中很常见，严重影响患者的生活质量。西地那非和伐地那非在接受肾透析或移植的患者中似乎有效且耐受良好。
