Sex hormones in women with kidney disease

Abstract

Menstrual disorders, infertility and premature menopause are common but often underrecognized phenomena among women with chronic kidney disease. Hypothalamic, rather than ovarian dysfunction, may be the cause of the abnormal reproductive milieu, which can be at least partially reversed by kidney transplantation and increased intensity of hemodialysis. Endogenous sex hormones, and specifically estradiol, appear to be renoprotective in women, although the effects of exogenous estradiol (as an oral contraceptive and postmenopausal hormone therapy) on kidney function are more controversial. Treatment with postmenopausal hormone therapy in women with end-stage kidney disease (ESKD) has been associated with improved quality of life, bone health and markers of cardiovascular risk, as well as an increased risk of arteriovenous access thrombosis. The selective estrogen receptor modulator raloxifene has been associated with both a decreased fracture risk as well as renoprotection in women with kidney disease. Young women with ESKD are more likely to die from infection or develop malignancy, suggesting an immunomodulatory role of estrogen. Whether the premature menopause commonly observed in female patients with kidney disease results in increased cardiovascular morbidity and mortality is unknown, although preliminary studies have suggested a possible therapeutic role for manipulation of the sex hormone milieu to mitigate risk in this population. Large, prospective, randomized studies examining the role of sex hormones in women with kidney disease are required to address the question.

Is quality of life associated with compliance to pharmacoterapy in patients with chronic kidney disease undergoing maintenance hemodialysis?

“…Physiological changes, such as hypothalamic and ovarian dysfunction caused by the disease and intensified by hemodialysis, made females more limited in their daily activities with a low perception as to their general health status. ( 19 ) This result contradicts the data obtained in previous studies, in which no significant difference was noted in any dimension of the SF-36 regarding the variable sex ( 20 ) or shown in the male gender as a disadvantage for better quality of life scores. ( 21 )…”

Klotho and Postmenopausal Hormone Replacement Therapy in Women with Chronic Kidney Disease

“…The protective effects of estrogen-based HRT against progression of CKD diminishes in accordance with aging and menopause status. 3 A study of 1,518 postmenopausal women reported a higher prevalence of microalbuminuria in HRT users (14.2%) than nonusers (11.6%) in women with >5 years of postmenopausal therapy. 30 In contrast, a study by Schopick et al 31 examining 2,445 nondiabetic women reported that women receiving HRT for >6 years exhibited lower overall urinary albumin-creatinine ratios than those not receiving treatment.…”

“…Development of CKD is associated with accelerated aging and is closely related with metabolic disorders (MD). Under normal conditions, estrogen attenuates renal pathology; however, as estrogen levels can decrease by as much as 80% during menopause, 3 this represents a significant risk for older women. It is therefore important to identify ways to preserve kidney function as patients' age.…”

A single dose of estrogen during hemorrhagic shock protects against Kidney Injury whereas estrogen restoration in ovariectomized mice is ineffective

“…This assumption is driven by both epidemiological data obtained before and after menopause in women and experimental data obtained in female rodents when comparing intact versus ovariectomized mice with or without estrogen restoration. These promising results are challenged by conflicting results in humans 26 . In particular, long-term estrogen treatment after menopause may negatively affect glomerular filtration rate in women with previous renal damages 27 .…”