Menopause in CKD.

Area of Science:

• Nephrology
• Endocrinology
• Women's Health

Background:

• Most women with dialysis-dependent chronic kidney disease (CKD) stage 5 (CKD stage 5D) are postmenopausal.
• Early menopause occurs across CKD stages 3-5D, complicating traditional definitions.
• Hormone replacement therapy (HRT) for vasomotor symptoms lacks specific dosing studies in CKD populations.

Purpose of the Study:

• To highlight the under-recognized challenges in managing menopause in CKD stage 5D patients.
• To emphasize the need for research on menopause's impact on cardiovascular disease and osteoporosis risk in CKD.
• To call for clinical trials to define menopause in CKD and evaluate HRT and osteoporosis treatments.

Main Methods:

• Review of existing literature on menopause in CKD and kidney transplantation.
• Identification of knowledge gaps in HRT and osteoporosis management for CKD patients.
• Proposal for longitudinal clinical trials.

Main Results:

• The traditional definition of menopause is inadequate for CKD stage 5D due to potential menses resumption with treatment.
• Cardiovascular disease and osteoporosis risks associated with menopause are poorly understood in the context of CKD.
• Current therapeutic options for menopause symptoms require specific testing in CKD and transplant populations.

Conclusions:

• Menopause in CKD stage 5D is a neglected clinical problem requiring specific management guidelines.
• CKD's influence on menopause transition and vice versa needs elucidation through dedicated research.
• Efficacy and safety of standard menopause treatments must be validated in CKD and kidney transplantation cohorts.