In clinical practice, the attention given to sexual problems in patients with end-stage renal disease is low. In order to evaluate the erectile function in chronic renal failure patients undergoing hemodialysis (HD) as a renal replacement therapy in upper Egypt, we used the abridged version of the International Index of Erectile Function (IIEF-5). In all, 75 HD patients were subjected to clinical and laboratory investigations. The controls were 948 healthy males representing the general Egyptian population. The prevalence of erectile dysfunction (ED) among the HD patients was 82.5% compared to 30% among controls. The prevalence of ED in HD group was significantly higher than in controls. The prevalence of ED in HD patients o50 y was 80% and it was 88% in those Z50 y, while the prevalence of ED among controls was 28 and 69.8%, respectively. The prevalence of severe degree of ED was significantly higher in both groups compared to controls, while moderate degree of ED showed a statistical significance compared to controls in age groups o50 y and mild degree of ED showed a statistical significance compared to controls in age groups Z50 y. The univariate logistic regression analysis showed that age (r ¼ À0.3368, Po0.01), serum urea (r ¼ À0.5974, Po0.001), and creatinine level (r ¼ À0.5804, Po0.001) have a significant negative correlation with the presence of ED among HD patients, while serum hemoglobin (r ¼ 0.3396, Po0.001) and years of HD age (r ¼ 0.3147, Po0.01) have a significant positive correlation with the presence of ED among the HD patients. In view of the observed high prevalence of ED among the HD patients, we believe that a complete health evaluation of male HD patients should include a discussion about erectile function in the standard clinical care program of patients with renal disease.