Chronic kidney disease (CKD) is a progressive, irreversible impairment of renal function lasting at least three months, leading to metabolic waste accumulation [1] . CKD is a global public health concern, affecting approximately 10% of the population, with regional prevalence ranging from 8% to 16% [2] . In Africa, CKD prevalence may reach up to 13% of adults [3] . In Cameroon, rising CKD prevalence is estimated between 12.8% [4] and 15% [5] , driven by increasing risk factors such as hypertension and diabetes [6] .

Chronic kidney disease (CKD) impacts multiple organ systems, including sexual function, with erectile dysfunction (ED) affecting 50% to 70% of CKD patients and causing psychological and relational challenges [7] [8] . ED in CKD involves vascular, neurological, and hormonal mechanisms [9] . CKD is also a significant risk factor for mortality, with global five-year mortality rates around 15% [10] . In Africa, CKD-related mortality can reach 25%, often due to cardiovascular complications [6] . In Cameroon, CKD patients face a heightened risk of death due to comorbidities [11] [12] .

Current knowledge on the prevalence and associated factors of erectile dysfunction (ED) among chronic haemodialysis patients in Cameroon is limited, with few studies providing insufficient guidance for patient management. This highlights the need for in-depth research to better understand the epidemiology of ED in this population. Assessing ED prevalence and associated factors in Cameroonian CKD patients could enhance the scientific literature, inform prevention and treatment strategies, and improve quality of life. Such research aims to raise awareness among healthcare professionals about the importance of a holistic approach to CKD management, addressing often-overlooked psychological and sexual health aspects. This study focused on determining the prevalence and associated factors of ED in chronic haemodialysis patients at the General Hospital of Douala.

Erectile dysfunction (ED) is a common yet under-addressed complication in chronic kidney disease (CKD) patients, significantly affecting their physical, emotional, and relational well-being. In sub-Saharan Africa, including Cameroon, limited resources and research on the CKD-ED link hinder comprehensive care. Identifying factors such as diabetes, hypertension, and psychosocial stress could inform targeted interventions, including psychological support, to improve treatment and quality of life for these patients. A study at the General Hospital of Douala is essential to determine ED prevalence and associated factors, enhancing management strategies for CKD patients.

Our study revealed that 76% of chronic haemodialysis patients experienced erectile dysfunction (ED), with 37% presenting moderate ED, 37% mild ED, and 21% severe ED. These findings are consistent with those of Navaneethan et al. (2010) [16] , who reported ED prevalence ranging from 70% to 80% among dialysis patients, and Zhang et al. (2014) [17] , who documented high rates of moderate-to-severe ED in advanced chronic kidney disease (CKD). In Cameroon, studies conducted by Mbanya et al. (2018) [18] and Tchouanguep et al. (2020) [19] also highlighted a high prevalence of ED among CKD patients, although they did not categorize its severity, limiting direct comparisons. Unlike studies conducted in settings with structured CKD and ED management systems, our study uniquely details the severity of ED in a Cameroonian context, offering critical insights for localized management strategies aimed at improving the quality of life of hemodialysis patients.

Erectile dysfunction in hemodialysis patients is multifactorial, involving vascular, hormonal, neurological, and psychological mechanisms. CKD and hemodialysis contribute to endothelial dysfunction, leading to reduced production of nitric oxide (NO), a key element for penile vasodilation during erection [20] . The accumulation of uremic toxins further exacerbates endothelial dysfunction, reducing blood flow to erectile tissues [21] . Additionally, CKD is associated with hypogonadism, caused by dysfunction of the hypothalamic-pituitary-gonadal axis, leading to decreased testosterone levels, which negatively affect libido and erectile function [22] . This hormonal imbalance, combined with vascular calcification induced by secondary hyperparathyroidism, further impairs penile blood flow. Uremic neuropathy also contributes to ED by damaging autonomic and somatic nerves, disrupting sensitivity and sexual response [23] .

Our study identified significant associations between ED and diabetes (aOR = 9.7, p = 0.002), stress (aOR = 1.67, p < 0.001), and marital problems (aOR = 1.76, p = 0.01). Diabetes is a well-documented risk factor for ED due to its microvascular and neuropathic complications, which damage small blood vessels and peripheral nerves, thereby reducing penile blood flow and sensitivity [24] . This condition is exacerbated in hemodialysis patients, where diabetes accelerates vascular calcification and endothelial dysfunction. Stress affects ED through neuroendocrine mechanisms, activating the hypothalamic-pituitary-adrenal (HPA) axis and increasing cortisol levels, which inhibit testosterone production and disrupt the balance of the autonomic nervous system [25] . Marital problems exacerbate ED by introducing a significant psychosocial dimension, including relational conflicts, reduced intimacy, and the emotional burden of chronic illness [26] .

Our findings align with those of Navaneethan et al. [16] , who identified diabetes as a key determinant of ED in hemodialysis patients, and Zhang et al. [17] , who emphasized the impact of stress on erectile function in this population. Similarly, Sullivan and Keane [27] described how relational conflicts worsen ED in patients with chronic illnesses. Unlike studies conducted in developed countries, where socioeconomic disparities and education levels significantly influence healthcare access, our results reveal relative homogeneity in these factors among the Cameroonian population. This reinforces the notion that ED severity is primarily driven by medical factors related to CKD rather than sociodemographic characteristics.

Identifying these risk factors highlights the need for a multidimensional approach to ED management in hemodialysis patients, including strict glycemic control, stress management, and psychosocial interventions targeting relational conflicts. Implementing these strategies could reduce the prevalence and severity of ED, thereby improving the quality of life of patients in similar settings.

This study reveals a high prevalence of erectile dysfunction (ED) among chronic hemodialysis patients followed up at the General Hospital of Douala, with 76% of participants experiencing erectile difficulties, including 37% with moderate ED, 37% with mild ED, and 21% with severe ED. The main factors associated with ED in this population include diabetes, stress, and marital problems. These results highlight the importance of considering psychological and relational comorbidities in the management of ED among chronic hemodialysis patients.

This study has some limitations. The small sample size and lack of a control group limit the generalizability of the results. Additionally, the cross-sectional design does not allow for causal relationships between CKD and the identified risk factors for ED. Lastly, the assessment of ED was based on self-reports, which could introduce social desirability bias.

We plan to conduct longitudinal studies with larger samples to assess trends in ED progression among CKD patients in Cameroon and to develop interventions tailored to their specific context.

We, the undersigned authors of the article titled “Prevalence and Associated Factors of Erectile Dysfunction in Chronic Kidney Disease Patients in Douala, Cameroon”, confirm that we have significantly contributed to its conception, writing, critical revision, and final approval. We attest that this manuscript is original, has not been published elsewhere, and is not under consideration by another journal. By this statement, we grant our consent for its publication by “Open Journal of Nephrology”, as well as its reproduction, distribution, and dissemination, in accordance with the journal’s policies. We also declare that all potential conflicts of interest and funding sources related to this work have been disclosed, and we collectively take responsibility for the published content.

The study received administrative authorisation and ethical approval from the General Hospital of Douala. Written informed consent to participate in this study was provided by the legal guardians/next of kin of the participants.

The original data supporting the conclusions of this article will be made available by the authors without undue reservation.

The authors state that the research was conducted in the absence of any external funding.

ENLPJ and ENFG designed the experimental approach and the writing plan. ENLPJ and NNE recruited the participants and conducted the laboratory analyses. ENLPJ performed the statistical analysis and prepared all the figures. ENLPJ drafted the manuscript. ENLPJ, ENFG, NNA, and FMEHD reviewed the manuscript. All the authors made substantial, direct, and intellectual contributions to the work and approved it for publication.

We express our gratitude to all the individuals who voluntarily participated in the study and to the staff of the hemodialysis department at the General Hospital for their unwavering support throughout the research process.