Hormone therapy and clinical and surrogate cardiovascular endpoints in women with chronic kidney disease: a systematic review and meta-analysis

Ramesh, Sharanya; Mann, Michelle; Holroyd‐Leduc, Jayna; Wilton, Stephen B.; James, Matthew T.; Seely, Ellen W.; Ahmed, Sofia B.

doi:10.1097/gme.0000000000000657

Cited by 10 publications

(6 citation statements)

References 49 publications

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“…Accordingly, the oral combination therapy with estradiol and norgestrel improved eGFR and proteinuria in T2DM postmenopausal women with hypertension, and this nephroprotective action was not related to the modification of conventional risk factors such as blood pressure and lipids [ 126 ]. Conversely, a recent meta-analysis demonstrated the short-term benefits of HRT on lipid profile in young women with CKD, although a reduction in CV morbidity and/or mortality was not observed [ 131 ].…”

Section: Impact Of Female Sex Hormones On Dkdmentioning

confidence: 99%

Gender Differences in Diabetic Kidney Disease: Focus on Hormonal, Genetic and Clinical Factors

Giandalia

Giuffrida

Gembillo

et al. 2021

IJMS

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Diabetic kidney disease (DKD) is one of the most serious complications of both type 1 (T1DM) and type 2 diabetes mellitus (T2DM). Current guidelines recommend a personalized approach in order to reduce the burden of DM and its complications. Recognizing sex and gender- differences in medicine is considered one of the first steps toward personalized medicine, but the gender issue in DM has been scarcely explored so far. Gender differences have been reported in the incidence and the prevalence of DKD, in its phenotypes and clinical manifestations, as well as in several risk factors, with a different impact in the two genders. Hormonal factors, especially estrogen loss, play a significant role in explaining these differences. Additionally, the impact of sex chromosomes as well as the influence of gene–sex interactions with several susceptibility genes for DKD have been investigated. In spite of the increasing evidence that sex and gender should be included in the evaluation of DKD, several open issues remain uncovered, including the potentially different effects of newly recommended drugs, such as SGLT2i and GLP1Ras. This narrative review explored current evidence on sex/gender differences in DKD, taking into account hormonal, genetic and clinical factors.

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Section: Impact Of Female Sex Hormones On Dkdmentioning

confidence: 99%

Gender Differences in Diabetic Kidney Disease: Focus on Hormonal, Genetic and Clinical Factors

Giandalia

Giuffrida

Gembillo

et al. 2021

IJMS

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“…53 Postmenopausal hormone therapy in the setting of kidney disease is associated with a lower low-density lipoprotein and higher high-density lipoprotein without any effects on triglycerides or blood pressure. 54 Studies examining the effect of postmenopausal hormone therapy on long-term CV outcomes in CKD and ESKD are lacking with those examining the effects of exogenous estrogen on albuminuria and GFR showing conflicting results [55][56][57] which likely reflect differences in estrogen doses, routes, concurrent use of progestins, and timing of initiation of therapy relative to menopausal onset.…”

Section: Estrogen and Kidney Diseasementioning

confidence: 99%

Providing Care for Transgender Persons With Kidney Disease: A Narrative Review

Collister

Saad

Christie

et al. 2021

Can J Kidney Health Dis

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Purpose of review: Nephrologists are increasingly providing care to transgender individuals with chronic kidney disease (CKD). However, they may lack familiarity with this patient population that faces unique challenges. The purpose of this review is to discuss the care of transgender persons and what nephrologists should be aware of when providing care to their transgender patients. Sources of information: Original research articles were identified from MEDLINE and Google Scholar using the search terms “transgender,” “gender,” “sex,” “chronic kidney disease,” “end stage kidney disease,” “dialysis,” “transplant,” and “nephrology.” Methods: A focused review and critical appraisal of existing literature regarding the provision of care to transgender men and women with CKD including dialysis and transplant to identify specific issues related to gender-affirming therapy and chronic disease management in transgender persons. Key findings: Transgender persons are at an increased risk of adverse outcomes compared with the cisgender population including mental health, cardiovascular disease, malignancy, sexually transmitted infections, and mortality. Individuals with CKD have a degree of hypogonadotropic hypogonadism and decreased levels of endogenous sex hormones; therefore, transgender persons with CKD may require reduced exogenous sex hormone dosing. Exogenous estradiol therapy increases the risk of venous thromboembolism and cardiovascular disease which may be further increased in CKD. Exogenous testosterone therapy increases the risk of polycythemia which should be closely monitored. The impact of gender-affirming hormone therapy on glomerular filtration rate (GFR) trajectory in CKD is unclear. Gender-affirming hormone therapy with testosterone, estradiol, and anti-androgen therapies changes body composition and lean body mass which influences creatinine generation and the performance for estimated glomerular filtration rate (eGFR) equations in transgender persons. Confirmation of eGFR with measured GFR is reasonable if an accurate knowledge of GFR is needed for clinical decision-making. Limitations: There are limited studies regarding the intersection of transgender persons and kidney disease and those that exist are mostly case reports. Randomized controlled trials and observational studies in nephrology do not routinely differentiate between cisgender and transgender participants. Implications: This review highlights important considerations for providing care to transgender persons with kidney disease. Additional research is needed to evaluate the performance of eGFR equations in transgender persons, the effects of gender-affirming hormone therapy, and the impact of being transgender on outcomes in persons with kidney disease.

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“…The knowledge gap on this issue likely reflects the paucity of literature on HT in this population; few studies have examined the role of HT specifically in women with kidney disease. [19][20][21][22][23][24][25] It is possible that discussion of clinical sequelae of low estrogen levels is limited due to lack of evidence for a viable treatment option in this population. Further clinical trials are required to determine the effectiveness and safety of postmenopausal HT in women with CKD.…”

Section: Discussionmentioning

confidence: 99%

“…Studies on the role of HT in the CKD population are limited. [19][20][21][22][23][24][25] Given the high prevalence of menstrual, pregnancy, and fertility disorders coupled with the early menopause observed in the CKD population, we sought to determine how health care providers in nephrology approach management of sex hormone status in women with CKD.…”

Section: Introductionmentioning

confidence: 99%

Sex Hormone Status in Women With Chronic Kidney Disease: Survey of Nephrologists’ and Renal Allied Health Care Providers’ Perceptions

Ramesh

James

Holroyd‐Leduc

et al. 2017

Can J Kidney Health Dis

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Background:Chronic kidney disease (CKD) in reproductive-age women is accompanied by menstrual and fertility disorders and premature menopause.Objective:We sought to determine nephrologists’ and allied health care providers’ perceptions on management of sex hormone status in women with CKD.Methods:An anonymous, Internet-based survey was sent to nephrology society members from Canada, Australia, New Zealand, and the United Kingdom, and the Canadian Association of Nephrology Nurses and Technologists (February-November 2015). We assessed reported perceptions and management of sex hormone status in women with CKD.Results:One hundred seventy-five nephrologists (21% response rate) and 121 allied health care providers (30%; 116 nurses, 5 pharmacists) responded. Sixty-eight percent of nephrologists and 46% of allied providers were between the ages of 30 and 50 years, and 38% of nephrologists and 89% of allied workers were female. Ninety-five percent of nephrologists agreed that kidney function impacts sex hormone status, although only a minority of nephrologists reported often discussing fertility (35%, female vs male nephrologists, P = .06) and menstrual irregularities with their patients (15%, female vs male nephrologists,P = .02). Transplant nephrologists reported discussing fertility more often than did nontransplant nephrologists (53% vs 30%, P = .03). Physicians were more likely to report discussing fertility (33% vs 7.5%, P < .001) and menstrual irregularities (15% vs 9%, P = .04) with patients than allied health care providers. Forty-three percent of physicians reported uncertainty about the role for postmenopausal hormone therapy in women with CKD.Conclusion:Nephrologists and allied health care providers recognize an impact of CKD on sex hormones in women but report not frequently discussing sex hormone–related issues with patients. Our international survey highlights an important knowledge gap in nephrology.

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Hormone therapy and clinical and surrogate cardiovascular endpoints in women with chronic kidney disease: a systematic review and meta-analysis

Abstract: Studies examining the effect of postmenopausal HT on CV outcomes in women with CKD are lacking. Further prospective study of the role of postmenopausal HT in this high-risk group is required.

Cited by 10 publications

References 49 publications

Gender Differences in Diabetic Kidney Disease: Focus on Hormonal, Genetic and Clinical Factors

Gender Differences in Diabetic Kidney Disease: Focus on Hormonal, Genetic and Clinical Factors

Providing Care for Transgender Persons With Kidney Disease: A Narrative Review

Sex Hormone Status in Women With Chronic Kidney Disease: Survey of Nephrologists’ and Renal Allied Health Care Providers’ Perceptions

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