# Kidney disease, COPD, excess weight and ED: what the research shows, and what it does not > Yes, long-term health conditions are linked to ED. The NIH names chronic kidney disease, obesity and overweight, and COPD among the most common conditions that can lead to it. Pooled studies found ED in about 70% of men with chronic kidney disease and 74% of people with COPD, but these are averages from observational research, not a prediction for any one man. Kidney and liver function can also change how ED medicines are handled, so these are conversations to have with a clinician who knows your full history. _Last updated: 2026-10-17_ --- **The short version:** erections depend on blood vessels, nerves and hormones, so it is not surprising that long-term health conditions show up in the research on erectile dysfunction. The National Institutes of Health lists chronic kidney disease, obesity and overweight, and chronic obstructive pulmonary disease (COPD) among the most common conditions that can lead to ED. This page walks through what the studies on each one found, how sure those findings are, how kidney and liver disease change the way ED medicines are handled, and what a clinician is likely to look at if you live with one of these conditions and have noticed changes in your erections. It is part of our [Causes and Conditions section](/topics/causes-and-health/). Our guide to [conditions often blamed for ED](/conditions-often-blamed-for-ed/) covers others, including COVID-19 and anemia. ## Which chronic health conditions are linked to ED? The NIH's National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) says that some diseases or conditions that affect your blood vessels, nerves or hormones can lead to ED. Its list of the most common ones includes diabetes, heart and blood vessel diseases, hormone issues, nerve damage, and "chronic health conditions, such as chronic kidney disease, obesity and overweight, and chronic obstructive pulmonary disease" ([NIDDK, Symptoms & Causes of ED](https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/symptoms-causes)). NIDDK also names obesity, alongside diabetes and heart disease, as a factor that makes ED more likely, and it is clear that ED is more common with age but is not a routine part of aging ([NIDDK, Definition & Facts](https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/definition-facts)). The American Urological Association (AUA) counts obesity and a sedentary lifestyle among the recognized independent risk factors that ED shares with cardiovascular disease ([AUA ED Guideline]()). For the full map of physical, medical and mental causes, start with our guide to [what causes erectile dysfunction](/what-causes-ed/). This page focuses on the three chronic conditions that get less attention. | Condition | What the research found | How sure it is | Worth raising with a clinician | | ---------------------- | ----------------------------------------------------------------------------------------------------------------------------------------------------- | --------------------------------------------------------------------------------------------- | -------------------------------------------------------------------- | | Chronic kidney disease | ED in about 70% of men with CKD, pooled from 21 studies and 4,389 patients | Observational and self-reported; rates varied with age, population and the questionnaire used | Your kidney function and stage, dialysis, diabetes and mood | | COPD | ED in 74% of 1,187 people with COPD across 12 studies; 56% of 224 age-matched people without it, from 4 studies that had a comparison group | The difference was not statistically significant and the authors call for more research | Breathing, activity, your medical history and the medicines you take | | Obesity and overweight | Named by NIDDK and the AUA as a risk factor; one 2-year trial in obese men measured erectile-function scores after a weight-loss and activity program | One randomized trial in a narrow group of men, plus guideline review | Weight, activity, diet and any related conditions | ## Which other conditions does the NIH link to ED? Beyond the three chronic conditions above, NIDDK's list of the most common diseases and conditions that can lead to ED has five more groups, and each one has its own page on this site. The list comes straight from [NIDDK's Symptoms & Causes page](https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/symptoms-causes); the right-hand column is where we cover it. | NIDDK group | Examples NIDDK names | Where we cover it | | --------------------------------- | -------------------------------------------------------- | -------------------------------------------------------------------------------------------------------------------- | | Diabetes | Diabetes | [ED and diabetes](/ed-and-diabetes/) | | Heart and blood vessel diseases | Atherosclerosis, high blood pressure, stroke | [Heart disease and ED treatment](/ed-and-heart-disease/), [ED and high blood pressure](/ed-and-high-blood-pressure/) | | Hormone issues | Low testosterone, thyroid imbalance | [Hormones and ED](/hormones-and-ed/), [ED and low testosterone](/ed-and-low-testosterone/) | | Nerve damage or disorders | Multiple sclerosis, spinal cord injuries, pelvic surgery | [Nerve conditions and ED](/nerve-conditions-and-ed/), [ED after prostate treatment](/ed-after-prostate-treatment/) | | Male reproductive system problems | Enlarged prostate, penile curvature (Peyronie's disease) | [Enlarged prostate and ED](/enlarged-prostate-and-ed/), [Peyronie's disease](/peyronies-disease/) | | Chronic health conditions | Chronic kidney disease, obesity and overweight, COPD | This page | NIDDK also lists medicines, mental health and emotional issues, and lifestyle behaviors such as low physical activity, heavy drinking and smoking as possible contributors, which is why a long-term condition is rarely the only thing a clinician looks at. ## Is chronic kidney disease linked to ED? Yes. NIDDK names chronic kidney disease (CKD) among the most common conditions that can lead to ED ([NIDDK](https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/symptoms-causes)), and the research shows ED is very common in men who have it. A 2010 systematic review and meta-analysis in the American Journal of Kidney Diseases pooled observational studies of people on dialysis, kidney transplant recipients, and people with CKD who were on neither. Its summary estimate of erectile dysfunction in men with CKD was 70%, from 21 studies and 4,389 patients, with a 95% confidence interval of 62% to 77% ([Navaneethan et al., Am J Kidney Dis 2010](https://pubmed.ncbi.nlm.nih.gov/20801572/)). That number needs its context. The studies measured self-reported sexual function, and the authors found that differences in rates between studies came mainly from age, the population studied and the questionnaire used. They list suboptimal and non-uniform measurement as a limitation. Across 20 individual studies, increasing age, diabetes and depression were consistently found to correlate with sexual dysfunction in people with CKD ([Navaneethan et al., 2010](https://pubmed.ncbi.nlm.nih.gov/20801572/)). A correlation like that tells you these factors travel together. It does not tell you which one, if any, is responsible in a particular man. Our guides to [ED and diabetes](/ed-and-diabetes/) and [ED and depression](/ed-and-depression/) cover those two overlaps. ## Is ED more common on dialysis? The same review points that way. Its authors concluded that sexual dysfunction is highly prevalent in people with CKD, "especially among those on dialysis" ([Navaneethan et al., 2010](https://pubmed.ncbi.nlm.nih.gov/20801572/)). Dialysis also matters for medicines. The Viagra label says dialysis "is not expected to accelerate clearance" of sildenafil, because the drug is highly bound to blood proteins and is not eliminated in the urine ([VIAGRA prescribing information, section 10, DailyMed](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=d905dc8d-917f-4ea3-a4ee-a1ecf6967d4e)), and the Cialis label says hemodialysis "contributes negligibly" to tadalafil elimination ([CIALIS prescribing information, section 10, DailyMed](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=bcd8f8ab-81a2-4891-83db-24a0b0e25895)). The Viagra patient leaflet asks men to tell their prescriber if they "have kidney problems or are having kidney dialysis" ([VIAGRA Patient Information](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=d905dc8d-917f-4ea3-a4ee-a1ecf6967d4e)). ## Does kidney disease change how ED medicines are handled? It can, which is one reason kidney history matters before any ED treatment decision. The AUA guideline advises that in men with mild to moderate kidney or liver impairment, PDE5 inhibitors (the drug family that includes sildenafil and tadalafil) "should be used with caution" because of "the potential for delayed metabolism", and that in severe kidney or liver disease their use "is generally not recommended" ([AUA ED Guideline]()). The two most-prescribed labels describe the effect in measured terms, and they are not identical. In volunteers with severe kidney impairment, the body cleared sildenafil more slowly and exposure roughly doubled compared with age-matched volunteers without kidney impairment, while mild and moderate impairment did not change its pharmacokinetics in a single-dose study ([VIAGRA prescribing information, sections 8.6 and 12.3](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=d905dc8d-917f-4ea3-a4ee-a1ecf6967d4e)). For tadalafil, exposure doubled even in people with mild to moderate kidney impairment, and the label says once-daily use is not recommended in severe kidney impairment, citing higher exposure, limited clinical experience and dialysis not being able to influence clearance ([CIALIS prescribing information, sections 5.7 and 8.7](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=bcd8f8ab-81a2-4891-83db-24a0b0e25895)). | Situation | Sildenafil (Viagra label) | Tadalafil (Cialis label) | | ------------------------------------ | ------------------------------------------------------------------------------- | ------------------------------------------------------------------------------------------------- | | Mild or moderate kidney impairment | Single-dose pharmacokinetics not changed | Exposure doubled in single-dose studies; the label sets limits for as-needed use | | Severe kidney impairment or dialysis | Clearance reduced, exposure about doubled; label suggests a lower starting dose | Once-daily use not recommended; as-needed use limited by the label | | Mild or moderate liver impairment | Clearance reduced, exposure higher; label suggests a lower starting dose | As-needed use limited by the label; once-daily use not extensively studied, so caution is advised | | Severe liver impairment | Not studied | Not recommended, because of insufficient information | The exact limits are dosing decisions, so they belong to the prescriber and are not repeated here. None of this is a reason to guess at your own plan. It is a reason to make sure whoever prescribes for you knows your kidney function and stage. Our guides to [sildenafil drug interactions](/sildenafil-drug-interactions/) and [tadalafil drug interactions](/tadalafil-drug-interactions/) cover the other medicines that need the same conversation. ## Does liver disease change how ED medicines are handled? Yes, according to both labels, though NIDDK does not list liver disease among the most common causes of ED itself. Sildenafil is cleared mainly by the liver. In volunteers with mild or moderate liver impairment (Child-Pugh class A and B), sildenafil exposure was higher, and the label notes that severe liver impairment has not been studied ([VIAGRA prescribing information, section 8.7](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=d905dc8d-917f-4ea3-a4ee-a1ecf6967d4e)). The Cialis label says once-daily tadalafil "has not been extensively evaluated" in mild or moderate liver impairment, so caution is advised, and that use in severe liver impairment is not recommended "because of insufficient information" ([CIALIS prescribing information, section 5.8](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=bcd8f8ab-81a2-4891-83db-24a0b0e25895)). The Viagra leaflet lists liver problems among the things to tell your prescriber before starting ([VIAGRA Patient Information](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=d905dc8d-917f-4ea3-a4ee-a1ecf6967d4e)). ## Does COPD affect erections? COPD is a lung condition, and NIDDK lists it with chronic kidney disease and obesity among the most common conditions that can lead to ED ([NIDDK](https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/symptoms-causes)). The research on how often the two occur together is newer and smaller than the kidney research. A 2022 systematic review and meta-analysis included 31 studies of sexual health in COPD. Twelve of them measured erectile function with the same validated questionnaire, and pooling those gave an ED rate of 74% in 1,187 patients with COPD. Only four of the studies also measured ED in an age-matched group without COPD, and pooling those 224 people gave 56%, a comparison the authors treat as exploratory ([Farver-Vestergaard et al., Int J COPD 2022](https://pmc.ncbi.nlm.nih.gov/articles/PMC8842639/)). The authors are careful about what that comparison means. They write that ED "appears to be more prevalent" among patients with COPD, but that more studies with non-COPD comparison groups are needed to confirm it. In their discussion they note the difference was not statistically significant, possibly because the comparison group was small. Within the COPD studies, higher average age went with more ED and better lung function went with less. Most people with COPD are current or former smokers, and smoking is linked to ED in the general population, but in this review the effects of smoking, body weight, how long someone had COPD and blood oxygen levels did not reach statistical significance, which the authors say may reflect too few studies and should be read with caution ([Farver-Vestergaard et al., 2022](https://pmc.ncbi.nlm.nih.gov/articles/PMC8842639/)). In the interview-based studies, people with COPD linked their sexual difficulties to shortness of breath and tiring easily, and described loss of intimacy and a partner's worry that something would go wrong. They also said their desire for sex was still there ([Farver-Vestergaard et al., 2022](https://pmc.ncbi.nlm.nih.gov/articles/PMC8842639/)). Our guide to [smoking and ED](/smoking-and-ed/) covers the smoking side of the picture. ## Is obesity linked to ED? Obesity shows up on every list in this area. NIDDK names "obesity and overweight" among the most common conditions that can lead to ED ([NIDDK, Symptoms & Causes](https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/symptoms-causes)) and lists obesity as a factor that makes ED more likely ([NIDDK, Definition & Facts](https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/definition-facts)). The AUA counts obesity and a sedentary lifestyle among the independent risk factors that ED and cardiovascular disease share ([AUA ED Guideline]()). NIDDK's own explanation is that a healthy weight can improve testosterone levels and self-esteem, which may help prevent ED, and can also help prevent diabetes and high blood pressure, both of which can cause ED ([NIDDK, Treatment for ED](https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/treatment)). Our guide to [ED and low testosterone](/ed-and-low-testosterone/) covers the hormone side of that link, and our page on [GLP-1 medicines and ED](/glp-1-medicines-and-ed/) looks at what is known about the newer weight-loss medicines. ## Can weight loss and activity change erectile function? One randomized trial looked at exactly this, in a specific group. It enrolled 110 obese men who had ED but no diabetes, high blood pressure or high cholesterol. Half got detailed advice on losing weight through eating less and moving more; the other half got general information on healthy food and exercise. After two years, average erectile-function scores rose from 13.9 to 17 in the advice group and stayed level in the comparison group, going from 13.5 to 13.6. Seventeen men in the advice group and three in the comparison group reached a score of 22 or higher, and the authors concluded that lifestyle changes were associated with improvement in about one third of the men ([Esposito et al., JAMA 2004](https://pubmed.ncbi.nlm.nih.gov/15213209/)). That is one trial in men without the other common conditions, so it does not tell you what would happen for you. The AUA, looking across the wider body of diet and exercise research in men with these conditions, describes the effect on erectile function as possibly small, with broader benefits for overall health. Its guideline asks clinicians to counsel men with ED who have conditions known to affect erectile function that lifestyle changes, including diet and more physical activity, "improve overall health and may improve erectile function" ([AUA ED Guideline, Statement 7]()). Our guides to [exercise and ED](/exercise-and-ed/) and [diet and ED](/diet-and-ed/) go through those trials, and our comparison of [natural remedies and medication for ED](/natural-remedies-for-ed-vs-medication/) covers where lifestyle change fits next to treatment. ## Does having a chronic condition mean it caused my ED? Not necessarily, and the research on this page cannot answer that for any one person. The kidney and COPD figures come from observational studies, which show how often two things occur together but cannot prove that one causes the other. Age, diabetes, depression, smoking and the medicines people take for long-term conditions all overlap, and NIDDK lists many common medicines, including blood pressure medicines and diuretics, as possible contributors to ED ([NIDDK](https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/symptoms-causes)). NIDDK is also clear that you should not stop any medicine on your own: a clinician may suggest a different dose or a switch instead ([NIDDK, Treatment for ED](https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/treatment)). Our guide to [medications that affect erections](/medications-that-affect-erections/) covers that list. The useful way to read these studies is as a reason to mention erection changes to the clinician who already manages your kidneys, lungs or weight, not as a verdict. ## What will a clinician look at if you have a chronic condition and ED? The evaluation is the same careful one any man with ED should get, with your condition as part of the history. NIDDK describes it as a medical, sexual and mental health history, a physical exam, and lab or other tests. The history covers prescribed and over-the-counter medicines, vitamins and supplements, and the exam often checks for blood vessel, nerve and hormone problems ([NIDDK, Diagnosis of ED](https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/diagnosis)). The AUA recommends a thorough medical, sexual and psychosocial history with a physical exam and selective lab testing, and says men should be counseled that ED is a risk marker for cardiovascular disease and other conditions that may need evaluation ([AUA ED Guideline]()). If you have kidney disease, expect questions about your kidney function, stage and any dialysis. If you have COPD, expect questions about breathing, activity and your inhalers and other medicines. Our guide to [how ED is diagnosed](/how-ed-is-diagnosed/) explains the tests, and [talking to a doctor about ED](/talking-to-a-doctor-about-ed/) covers how to raise it with the clinician you already see. If you are unsure whether it is time to book that visit, our guide on [when to see a doctor about ED](/when-to-see-a-doctor-about-ed/) sets out what the first appointment usually involves. ## The bottom line Chronic kidney disease, COPD, and obesity and overweight are on the NIH's list of common conditions that can lead to ED. Pooled studies found ED in about 70% of men with chronic kidney disease and in 74% of people with COPD, though the COPD comparison with people without the condition is not yet settled, and neither figure predicts what will happen to any one man. Kidney and liver function can change how ED medicines are handled, and the sildenafil and tadalafil labels treat them differently, which makes your full history part of any treatment decision. The steady next step is to raise erection changes with the clinician who already knows your condition. ## Sources Every clinical statement on this page traces to a primary or guideline source: - [NIH NIDDK, Symptoms & Causes of Erectile Dysfunction (last reviewed October 2024)](https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/symptoms-causes): the most common diseases and conditions that can lead to ED (including chronic kidney disease, obesity and overweight, and COPD), and the medicines, mental health and lifestyle contributors. - [NIH NIDDK, Definition & Facts for Erectile Dysfunction (last reviewed October 2024)](https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/definition-facts): obesity as a factor that makes ED more likely, and ED as more common with age but not a routine part of aging. - [NIH NIDDK, Diagnosis of Erectile Dysfunction (last reviewed October 2024)](https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/diagnosis): the medical, sexual and mental health history, medicine review, physical exam and tests used to diagnose ED. - [NIH NIDDK, Treatment for Erectile Dysfunction (last reviewed October 2024)](https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/treatment): healthy weight and testosterone, self-esteem, diabetes and blood pressure, and not stopping medicines on your own. - [Navaneethan SD, et al. Prevalence and correlates of self-reported sexual dysfunction in CKD: a meta-analysis of observational studies (Am J Kidney Dis, 2010)](https://pubmed.ncbi.nlm.nih.gov/20801572/): summary ED estimate of 70% (95% CI 62% to 77%; 21 studies, 4,389 patients), sources of variation, higher prevalence on dialysis, and age, diabetes and depression as correlates. - [Farver-Vestergaard I, et al. Sexual Health in COPD: A Systematic Review and Meta-Analysis (Int J Chron Obstruct Pulmon Dis, 2022)](https://pmc.ncbi.nlm.nih.gov/articles/PMC8842639/): 31 studies; pooled ED of 74% in 1,187 people with COPD (12 studies) versus 56% in 224 age-matched controls (4 studies, exploratory), the non-significant difference, moderators, qualitative findings and the call for more controlled studies. - [American Urological Association, Erectile Dysfunction Guideline (Burnett et al., J Urol 2018)](): obesity and sedentary lifestyle as shared risk factors, caution with PDE5 inhibitors in kidney or liver impairment, Statement 7 on lifestyle counseling and its evidence review, and the evaluation and risk-marker statements. - [VIAGRA (sildenafil citrate) prescribing information and Patient Information, Viatris, DailyMed](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=d905dc8d-917f-4ea3-a4ee-a1ecf6967d4e): sections 8.6 and 12.3 (reduced clearance and roughly doubled exposure in severe kidney impairment, no change in mild or moderate impairment in a single-dose study), 8.7 (liver impairment), 10 (dialysis not expected to speed clearance), and the leaflet's kidney, dialysis and liver questions. - [CIALIS (tadalafil) prescribing information, Eli Lilly, DailyMed](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=bcd8f8ab-81a2-4891-83db-24a0b0e25895): sections 5.7 and 8.7 (kidney impairment and dialysis; once-daily use not recommended in severe impairment), 5.8 (liver impairment) and 10 (hemodialysis contributes negligibly to elimination). - [Esposito K, et al. Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial (JAMA, 2004)](https://pubmed.ncbi.nlm.nih.gov/15213209/): 110 obese men without diabetes, hypertension or hyperlipidemia; two-year erectile-function score results and the authors' conclusion. --- _Affiliate disclosure: some links on the web version of this site go to Bodybuilding Peptides (trybbpeptides.com), an affiliate destination, and we may earn a commission if you buy there. Our coverage is independent of that relationship. Details: https://theedreport.com/affiliate-disclosure/_