Qian Duo, Wang Zu-Feng, Cheng Yi-Chun, Luo Ran, Ge Shu-Wang, Xu Gang
Division of Internal Medicine, Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Front Med (Lausanne). 2022 Mar 18;9:823835. doi: 10.3389/fmed.2022.823835. eCollection 2022.
Chronic kidney disease (CKD) in women is often accompanied by hormone disorders such as sex hormones, and most women with CKD are in the post-menopausal age group. Due to the close relationship between menopause and sex hormones, we aimed to explore the association between early menopause and CKD in post-menopausal women, and the influence of early menopause on longevity in the CKD population.
Information regarding 4,945 post-menopausal women was extracted from the database of the National Health and Nutrition Examination Survey (NHANES) 1999-2014, and then divided into 4 groups according to the type of menopause (natural or surgical) and early menopause (menopause at age <45) or not. The association between early menopause and CKD prevalence was examined using multivariable logistic regression, while we used multivariable Cox proportional hazards models to investigate the possible relationship between early menopause and all-cause mortality in CKD and non-CKD populations. The differences in the levels of sex hormones between women with and without CKD were also explored.
Compared with women with natural menopause at age ≥45, women experiencing early natural menopause had a higher risk of CKD [OR = 1.26 (1.01-1.56)]. Similarly, as compared to women with surgical menopause at age ≥ 45, women in the early surgical menopause group were more likely to have CKD [OR = 1.38 (1.05-1.81)]. In addition, early surgical menopause was associated with higher mortality in the non-CKD group [HR = 1.62 (1.06-2.49)], but not in the CKD group. Women with CKD had a higher level of luteinizing hormone and follicle-stimulating hormone, combined with a lower level of testosterone and estradiol than the non-CKD women.
Both early natural and surgical menopause were associated with a higher risk of CKD. Early surgical menopause was a hazard factor for survival in the non-CKD group, but not in the CKD group. Further research is required to understand the mechanisms.
女性慢性肾脏病（CKD）常伴有性激素等激素紊乱，且大多数CKD女性处于绝经后年龄组。由于绝经与性激素关系密切，我们旨在探讨绝经后女性过早绝经与CKD之间的关联，以及过早绝经对CKD人群寿命的影响。
从1999 - 2014年美国国家健康与营养检查调查（NHANES）数据库中提取4945名绝经后女性的信息，然后根据绝经类型（自然绝经或手术绝经）以及是否过早绝经（45岁之前绝经）分为4组。使用多变量逻辑回归分析过早绝经与CKD患病率之间的关联，同时使用多变量Cox比例风险模型研究过早绝经与CKD和非CKD人群全因死亡率之间的可能关系。还探讨了有无CKD女性之间性激素水平的差异。
与45岁及以上自然绝经的女性相比，过早自然绝经的女性患CKD的风险更高[比值比（OR）= 1.26（1.01 - 1.56）]。同样，与45岁及以上手术绝经的女性相比，早期手术绝经组的女性更易患CKD[OR = 1.38（1.05 - 1.81）]。此外，早期手术绝经与非CKD组较高的死亡率相关[风险比（HR）= 1.62（1.06 - 2.49）]，但与CKD组无关。与非CKD女性相比，CKD女性的黄体生成素和卵泡刺激素水平较高，而睾酮和雌二醇水平较低。
过早自然绝经和手术绝经均与较高的CKD风险相关。早期手术绝经是非CKD组生存的危险因素，但不是CKD组的危险因素。需要进一步研究以了解其机制。
