SP336
PROGNOSTIC IMPACT OF THE SIMPLIFIED INTERNATIONAL INDEX OF ERECTILE FUNCTION IN PATIENTS WITH CHRONIC KIDNEY DISEASE STAGES 3-5

Introduction and Aims: Erectile dysfunction (ED) associates with increased risk for cardiovascular disease (CVD) and all-cause mortality in the community. The simplified international index of erectile function (IIEF-5) is an easily-accessible tool to assess and grade erectile function. Here we evaluated the clinical correlates and prognostic value of IIEF-5 among non-dialyzed chronic kidney disease (CKD) patients.

Methods: We included 181 non-dialyzed male patients (median age 61, interquartile range 53-68 years) with CKD stages 3-5. Patients were followed for 35 (23 - 42) months for overall mortality, with no loss of follow-up.

Results: With decreasing IIEF-5 quartiles (middle quartiles combined) patients were older, had higher prevalence of diabetes mellitus (DM), ischemic heart disease (IHD) and peripheral vascular disease (PVD), as well as higher serum brain natriuretic peptide levels; while diastolic blood pressure, and free testosterone levels were progressively reduced. During follow-up, 49 patients died, and the mortality risk decreased across the quartiles (36% vs. 32% vs. 14% log-rank X2 = 9.42; P = 0.009). A 1 point higher IIEF-5 was associated with a reduced hazard ratio (HR) for mortality in crude Cox analysis (HR 0.95, 95% confidence interval (CI) 0.92-0.99). This association remained significant even after adjustment for confounders (age, glomerular filtration rate, DM and serum albumin (adjusted final HR 0.95 [95% CI 0.91-99]). In search of potential mechanisms explaining the impact of IIEF-5 on the patient's mortality, we performed two different models, including IHD or PVD as covariates. While the inclusion of IHD did not change the association between IIEF-5 and mortality (HR: 0.95 [95% CI 0.91-99]), the association lost its significance when PVD was included in the model (HR: 0.96 [95% CI 0.91-1.01]).

Conclusions: IIFE-5 associates with CVD risk factors and predicts overall mortality among non-dialyzed CKD stages 3-5 patients, probably reflecting peripheral vascular disease. These results support the routine evaluation of erectile dysfunction on CKD patients. Future studies are warranted to establish IIEF-5 as a risk stratification tool in this patient population.