ORIGINAL ARTICLE Effects of sildenafil and vardenafil treatments on sleep quality and depression in hemodialysis patients with erectile dysfunction Y Solak 1 , H Atalay 1 , S Kan 2 , M Kaynar 3 , S Bodur 4 , M Yeksan 1 and S Turk 1 1 Department of Nephrology, Meram School of Medicine, Selcuk University, Konya, Turkey; 2 Department of Internal Medicine, Meram School of Medicine, Selcuk University, Konya, Turkey; 3 Department of Urology, Meram School of Medicine, Selcuk University, Konya, Turkey and 4 Department of Public Health, Meram School of Medicine, Selcuk University, Konya, Turkey ED is prevalent in hemodialysis (HD) patients, and closely related to poor sleep and depression. Efficacy of treating ED either with sildenafilor vardenafil has been shown to be beneficial in ameliorating concomitant depression in non-HD patients. It is yet to be shown whether treatment of ED with a PDE-5 inhibitor would improve poor sleep in HD patients. We aimed to compare the effects of sildenafil and vardenafil on sleep quality and depression in HD patients with ED. A total of 32 maintenance HD patients with ED randomized into two groups to receive either sildenafil or vardenafil for 4 weeks. After a 2-week washout and a crossover, each group received the other drug for another 4-week period. Sleep quality and depression were evaluated via post-sleep inventory (PSI) and Beck’s depression inventory (BDI),respectively,at baseline and at the end of the treatment. Sildenafil and vardenafil both improved PSI and BDI scores significantly compared with pretreatmentvalues.However,there was no difference between sildenafil and vardenafil with respectto these parameters.PDE-5 inhibitors, sildenafil and vardenafil, caused a significant improvement in sleep quality and depression in this cohort of HD patients with ED. International Journal of Impotence Research (2011) 23, 27–31; doi:10.1038/ijir.2010.32; published online 6 January 2011 Keywords: depression; erectile dysfunction; sleep quality; sildenafil; vardenafil Introduction ED is prevalent among hemodialysis (HD) patients, and closely associated with poor sleep quality and depression. Prevalence ratesranging between 70 and 82% have been reported. 1 Sildenafil, a PDE-5 inhibitor, has been shown to be very effective against ED in a number of underlying causes to date. 2 Sildenafil has also been tested and shown to be effective in HD patients. 1 However, up to 20% of patients are resistant to sildenafil treatment includ- ing severe diabetic patients. 3 Vardenafil, a more potent PDE-5 inhibitor,has been effective in silde- nafil-unresponsive patientswhen compared with placebo. 4 However, safety and efficacy of vardenafil are yet to be evaluated in HD population. The importance ofdepression in HD patients is twofold: it is very common and presence of depres- sion is an independent determinantof mortality. There is a close relation between depression and ED, each feeding the other. 5 Thus, treating one condi- tion, whereas not considering the other may result in failure. Furthermore, selective serotonin reuptake inhibitors are associated with developmentof ED per se. 6 A few studies have investigated the effect of treatmentof ED with sildenafil and vardenafil on concomitant untreated depression and showed favorable results. However, to the best of our knowledge, this beneficial effect has never been studied in HD patients. 7,8 Depression and ED are both associated with poor sleep quality. 9,10 However, it is not known yet whether treatmentof ED with PDE-5 inhibitors would be beneficial in terms of sleep quality in HD patients. In this present study, we aimed to compare the effects of sildenafil and vardenafil on depression and sleep quality in HD patients with ED. Received 7 August 2010; revised 29 September2010; accepted 11 November 2010; published online 6 January 2011 Correspondence: Dr Y Solak, Departmentof Nephrology, Meram School of Medicine, Selcuk University, Selcuk Universitesi Meram Tip Fakultesi Hemodiyaliz Sekreterligi, Meram, Konya 42090, Turkey. E-mail: yalcinsolakmd@gmail.com International Journal of Impotence Research (2011) 23, 27–31 & 2011 Macmillan Publishers Limited All rights reserved0955-9930/11 www.nature.com/ijir