Is there a link between Chronic Kidney Disease (CKD) and low sperm count or abnormal sperm?

Link Between Chronic Kidney Disease and Male Reproductive Abnormalities

Yes, there is a clear link between chronic kidney disease (CKD) and abnormal sperm parameters, including low sperm count and other sperm abnormalities. 1 This association is documented in clinical practice guidelines and research studies.

Evidence of Reproductive Abnormalities in CKD

Sperm Abnormalities

• The KDIGO 2025 clinical practice guideline explicitly states that men with CKD show "abnormal semen parameters" 1
• Specific abnormalities documented in men with CKD include:
  • Decreased volume of ejaculate
  • Oligospermia (low sperm count)
  • Complete azoospermia in some cases
  • Low percentage of motile sperm 2
  • Impaired spermatogenesis and testicular damage 2, 3

Pathophysiological Mechanisms

The reproductive dysfunction in CKD occurs through several mechanisms:

1. Hormonal Disturbances:

   • Hypergonadotropic hypogonadism
   • Hyperprolactinemia 4
   • Dysfunction of the hypothalamic-pituitary-gonadal axis 5

2. Direct Effects on Spermatogenesis:

   • Spermatotoxicity
   • Late-stage maturational arrest of sperm development 3
   • Uremic environment affecting testicular function

3. Biomarkers of Subfertility:

   • Elevated microRNA-155 (miR-155) levels in men with CKD stages 1-4 are associated with lower sperm concentration and total sperm number 6
   • Decreased Anti-Müllerian hormone (AMH), a marker of Sertoli cell function, is associated with reduced sperm motility 6

Severity of Reproductive Dysfunction by CKD Stage

• Early CKD (Stages 1-2): Reproductive abnormalities begin to appear with elevated miR-155 levels 6
• Moderate CKD (Stages 3-4): Significantly lower sperm concentrations (42 ± 29 × 10^6/mL) compared to healthy controls (88 ± 42 × 10^6/mL) 6
• End-Stage Renal Disease (Stage 5): Most severe reproductive dysfunction with multiple abnormalities in semen parameters and frequent infertility 2, 3

Effect of Kidney Transplantation

Kidney transplantation can partially reverse reproductive abnormalities:

• Normalization of reproductive hormonal parameters
• Improvement in semen parameters (count, motility, morphology)
• Partial restoration of erectile function 3
• Regular improvement in sperm parameters occurs within 2 years post-transplant, though some abnormalities may persist due to immunosuppressive medications 4

Clinical Implications

For male CKD patients concerned about fertility:

• Fertility evaluation should be considered early in the disease course
• Sperm banking might be appropriate before advanced CKD develops
• Assisted reproductive technologies may be required for those with persistent abnormalities
• Kidney transplantation should be considered as a potential strategy to improve reproductive function in appropriate candidates

Monitoring Recommendations

• Consider using miR-155 and AMH as potential biomarkers of subfertility in men with CKD 6
• Regular assessment of reproductive function in men with CKD who are of reproductive age or concerned about fertility

The evidence clearly demonstrates that CKD negatively impacts male reproductive function, with effects becoming more pronounced as kidney function declines. These reproductive abnormalities should be recognized as important aspects of care for male CKD patients of reproductive age.