Division of Nephrology and Hypertension, Department of Internal Medicine.
Divisions of Biomedical Statistics and Informatics and.
Clin J Am Soc Nephrol. 2018 Nov 7;13(11):1649-1658. doi: 10.2215/CJN.03990318. Epub 2018 Sep 19.
Premenopausal women who undergo bilateral oophorectomy are at a higher risk of morbidity and mortality. Given the potential benefits of estrogen on kidney function, we hypothesized that women who undergo bilateral oophorectomy are at higher risk of CKD.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We performed a population-based cohort study of 1653 women residing in Olmsted County, Minnesota who underwent bilateral oophorectomy before age 50 years old and before the onset of menopause from 1988 to 2007. These women were matched by age (±1 year) to 1653 referent women who did not undergo oophorectomy. Women were followed over a median of 14 years to assess the incidence of CKD. CKD was primarily defined using eGFR (eGFR<60 ml/min per 1.73 m on two occasions >90 days apart). Hazard ratios were derived using Cox proportional hazards models, and absolute risk increases were derived using Kaplan-Meier curves at 20 years. All analyses were adjusted for 17 chronic conditions present at index date, race, education, body mass index, smoking, age, and calendar year.
Women who underwent bilateral oophorectomy had a higher risk of eGFR-based CKD (211 events for oophorectomy and 131 for referent women; adjusted hazard ratio, 1.42; 95% confidence interval, 1.14 to 1.77; absolute risk increase, 6.6%). The risk was higher in women who underwent oophorectomy at age ≤45 years old (110 events for oophorectomy and 60 for referent women; adjusted hazard ratio, 1.59; 95% confidence interval, 1.15 to 2.19; absolute risk increase, 7.5%).
Premenopausal women who undergo bilateral oophorectomy, particularly those ≤45 years old, are at higher risk of developing CKD, even after adjusting for multiple chronic conditions and other possible confounders present at index date.
This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2018_10_11_CJASNPodcast_18_1.
接受双侧卵巢切除术的绝经前女性发生发病率和死亡率的风险较高。鉴于雌激素对肾功能的潜在益处，我们假设接受双侧卵巢切除术的女性发生慢性肾脏病的风险更高。
设计、设置、参与者和测量方法：我们进行了一项基于人群的队列研究，纳入了 1988 年至 2007 年期间居住在明尼苏达州奥姆斯特德县、50 岁之前且在绝经前接受过双侧卵巢切除术的 1653 名女性。这些女性按年龄（±1 岁）与未接受卵巢切除术的 1653 名对照女性相匹配。中位随访时间为 14 年，以评估慢性肾脏病的发生率。慢性肾脏病主要通过估算肾小球滤过率（eGFR，两次相隔≥90 天的 eGFR<60 ml/min/1.73 m ）进行定义。使用 Cox 比例风险模型得出风险比，使用 Kaplan-Meier 曲线在 20 年时得出绝对风险增加。所有分析均调整了指数日期时存在的 17 种慢性疾病、种族、教育程度、体重指数、吸烟、年龄和日历年度。
接受双侧卵巢切除术的女性发生基于 eGFR 的慢性肾脏病的风险更高（卵巢切除术组有 211 例事件，对照组有 131 例；调整后的风险比为 1.42；95%置信区间为 1.14 至 1.77；绝对风险增加为 6.6%）。在≤45 岁接受卵巢切除术的女性中，风险更高（卵巢切除术组有 110 例事件，对照组有 60 例；调整后的风险比为 1.59；95%置信区间为 1.15 至 2.19；绝对风险增加为 7.5%）。
接受双侧卵巢切除术的绝经前女性，尤其是≤45 岁的女性，发生慢性肾脏病的风险更高，即使在调整了指数日期时存在的多种慢性疾病和其他可能的混杂因素后也是如此。
本文包含播客，请访问 https://www.asn-online.org/media/podcast/CJASN/2018_10_11_CJASNPodcast_18_1。
