Sexual dysfunction and effect on quality of life in chronic kidney disease: a systematic review and meta-analysis

Abstract

BACKGROUND: Sexual dysfunction in chronic kidney disease (CKD) is frequently underrecognized and underreported worldwide, despite its well-established association with depression and reduced quality of life (QoL). This study estimated the pooled global prevalence of sexual dysfunction among individuals with CKD and evaluated its impact on psychosocial well-being. METHODS: A systematic review and meta-analysis of published studies examining sexual dysfunction in CKD was conducted following PRISMA 2020 guidelines (PROSPERO: CRD42024508777). Pooled prevalence estimates were calculated using a DerSimonian-Laird random-effects model with Freeman-Tukey double arcsine transformation, and correlation coefficients were pooled following Fisher's Z transformation. RESULTS: Forty-four eligible studies, involving 10,672 participants from 18 countries, were included. The overall pooled prevalence of sexual dysfunction was 71.2% (95% CI: 65.9-76.3%, I²= 96.8%), with no significant difference across geographical regions (p = 0.87) or between males (71.5%, 95% CI: 65.5-77.3%) and females (67.3%, 95% CI: 52.6-80.5%) (p = 0.61). Prevalence was significantly higher among patients on hemodialysis (77.6%) and those in predialysis stage (76.7%) compared with post-kidney transplant recipients (56.9%), with a significant difference across patient groups (p = 0.01). Sexual dysfunction was significantly correlated with poorer mental (r ≈ 0.36, 95% CI: 0.27-0.45, p < 0.001) and physical (r ≈ 0.39, 95% CI: 0.29-0.48, p < 0.001) health-related quality of life, as well as greater depression severity as measured by the IIEF (r = -0.34, p < 0.001) and FSFI (r = -0.42, p < 0.001). No significant publication bias was observed on Begg's test (p = 0.48) or Egger's test (p = 0.16). CONCLUSION: Sexual dysfunction is highly prevalent among individuals with CKD, affecting more than two-thirds of patients and varying by treatment modality, with lower prevalence observed after kidney transplantation. It is significantly associated with poorer quality of life and depression severity. These findings underscore the need for routine screening and integrated psychological and sexual health interventions in CKD care.