慢性肾脏病女性的绝经症状
Menopausal symptoms in women with chronic kidney disease.
作者信息
Cheung Katharine L, Stefanick Marcia L, Allison Matthew A, LeBlanc Erin S, Vitolins Mara Z, Shara Nawar, Chertow Glenn M, Winkelmayer Wolfgang C, Kurella Tamura Manjula
机构信息
1Division of Nephrology, University of Vermont College of Medicine, Burlington, VT 2Department of Medicine, Stanford Prevention Research Center, Palo Alto, CA 3Department of Obstetrics and Gynecology, Stanford University, Palo Alto, CA 4University of California San Diego, San Diego, CA 5Kaiser Permanente Center for Health Research NW, Portland, OR 6Wake Forest School of Medicine, Winston-Salem, NC 7MedStar Health Research Institute, Georgetown University, Washington, DC 8Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA 9Section of Nephrology, Baylor College of Medicine, Houston, TX 10Geriatric Research and Education Clinical Center, Veterans Affairs Palo Alto Health Care System, California.
出版信息
Menopause. 2015 Sep;22(9):1006-11. doi: 10.1097/GME.0000000000000416.
OBJECTIVE
This study aims to determine whether menopausal symptoms differed between women with chronic kidney disease (CKD) and women without CKD, and whether CKD modified associations of late vasomotor symptoms (VMS) with mortality and/or cardiovascular events.
METHODS
CKD, defined as estimated glomerular filtration rate lower than 60 mL/minute/1.73 m (using the Chronic Kidney Disease Epidemiology Collaboration equation), was determined in 17,891 postmenopausal women, aged 50 to 79 years at baseline, in the multiethnic Women's Health Initiative cohort. Primary outcomes were presence, severity, and timing/duration of VMS (self-reported hot flashes and night sweats) at baseline. We used polytomous logistic regression to test for associations among CKD and four VMS categories (no VMS; early VMS-present before menopause but not at study baseline; late VMS-present only at study baseline; persistent VMS-present before menopause and study baseline) and Cox regression to determine whether CKD modified associations between late VMS and mortality or cardiovascular events.
RESULTS
Women with CKD (1,017 of 17,891; mean estimated glomerular filtration rate, 50.7 mL/min/1.73 m) were more likely to have had menopause before age 45 years (26% vs 23%, P = 0.02) but were less likely to experience VMS (38% vs 46%, P < 0.001) than women without CKD. Women with CKD were not more likely than women without CKD to experience late VMS. Late VMS (hazard ratio, 1.16; 95% CI, 1.04-1.29) and CKD (hazard ratio, 1.74; 95% CI, 1.54-1.97) were each independently associated with increased risk for mortality, but CKD did not modify the association of late VMS with mortality (Pinteraction = 0.53), coronary heart disease (Pinteraction = 0.12), or stroke (Pinteraction = 0.68).
CONCLUSIONS
Women with mild CKD experience earlier menopause and fewer VMS than women without CKD.
目的
本研究旨在确定慢性肾脏病（CKD）女性与非CKD女性的更年期症状是否存在差异，以及CKD是否会改变晚期血管舒缩症状（VMS）与死亡率和/或心血管事件之间的关联。
方法
在多民族女性健康倡议队列中，对17891名基线年龄为50至79岁的绝经后女性进行了CKD评估，CKD定义为估算肾小球滤过率低于60ml/分钟/1.73m²（使用慢性肾脏病流行病学协作组方程）。主要结局为基线时VMS（自我报告的潮热和盗汗）的存在情况、严重程度以及发生时间/持续时间。我们使用多分类逻辑回归来检验CKD与四个VMS类别（无VMS；早期VMS - 绝经前出现但研究基线时未出现；晚期VMS - 仅在研究基线时出现；持续性VMS - 绝经前和研究基线时均出现）之间的关联，并使用Cox回归来确定CKD是否会改变晚期VMS与死亡率或心血管事件之间的关联。
结果
CKD女性（17891名中的1017名；平均估算肾小球滤过率为50.7ml/分钟/1.73m²）比非CKD女性更有可能在45岁之前绝经（26%对23%，P = 0.02），但经历VMS的可能性较小（38%对46%，P < 0.001）。CKD女性经历晚期VMS的可能性并不高于非CKD女性。晚期VMS（风险比，1.16；95%置信区间，1.04 - 1.29）和CKD（风险比，1.74；95%置信区间，1.54 - 1.97）各自独立与死亡风险增加相关，但CKD并未改变晚期VMS与死亡率（交互作用P = 0.53）、冠心病（交互作用P = 0.12）或中风（交互作用P = 0.68）之间的关联。
结论
轻度CKD女性比非CKD女性绝经更早且VMS更少。
Zotero 插件