Menopause and Chronic Kidney Disease

Premature menopause defined as secondary amenorrhea is common in women with kidney disease. Moreover, the aging population has resulted in increasing numbers of postmenopausal women with kidney disease. Though the pathophysiology is poorly understood, kidney transplantation and more frequent hemodialysis can restore menses and fertility, highlighting the challenges of diagnosing and managing the menopausal transition in the female population with kidney disease. Postmenopausal sex hormone levels affect renovascular physiology, but the clinical impact of menopause on kidney function is unclear. There are no guidelines on the use of postmenopausal hormone therapy specific to the population with kidney disease, and studies on the effects of postmenopausal hormone therapy in patients with kidney disease are limited to surrogate measures of cardiovascular and fracture risk. Studies examining the effects of postmenopausal hormone therapy on kidney function and albuminuria report conflicting results, which is likely reflective of differences in formulation, route of administration, accompanying progestin, and timing of initiation of treatment. Large, prospective studies examining the relationship between kidney function and menopause as well as the effects of postmenopausal hormone therapy on important clinical outcomes in women with kidney disease are warranted.