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Chronic kidney disease and menopausal health: An EMAS clinical guide
E Cansu Cevik1, C Tamer Erel2, Ipek Betul Ozcivit Erkan2
1Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT 06520, USA.
Abstract:
Kidney diseases are related to the aging process. Ovarian senescence and the loss of estrogen's renoprotective effects are directly associated with a decline in renal function and indirectly with an accumulation of cardiometabolic risk factors. The latter can predispose to the development of chronic kidney disease (CKD). Conversely, CKD diagnosed during reproductive life adversely affects ovarian function.
Aim:
To set out an individualized approach to menopause management in women with CKD.
Materials And Methods:
Literature review and consensus of expert opinion.
Summary Recommendations:
Menopause hormone therapy can be given to women with CKD. The regimen should be selected on the basis of patient preference and the individual's cardiovascular risk. The dose of hormonal and non-hormonal preparations should be adjusted in accordance with the patient's creatinine clearance. The management of a postmenopausal woman with CKD should focus on lifestyle advice as well as regular monitoring of the main cardiovascular risk factors and evaluation of bone mineral density. Tailored multidisciplinary advice should be given to women with comorbidities such as diabetes, dyslipidemia, and hypertension. Management of osteoporosis should be based on the severity of the CKD.
Insights
Menopause hormone therapy is safe for women with chronic kidney disease (CKD). Individualized treatment plans, considering cardiovascular risk and creatinine clearance, are essential for managing menopause in CKD patients.
Area of Science:
- Nephrology
- Gynecology
- Endocrinology
Background:
- Kidney diseases are linked to aging and ovarian senescence.
- Estrogen loss in menopause reduces renal protection, increasing cardiometabolic risk and chronic kidney disease (CKD) risk.
- CKD can negatively impact ovarian function in women of reproductive age.
Purpose of the Study:
- To establish an individualized approach for managing menopause in women diagnosed with CKD.
- To provide guidance on hormone therapy and non-hormonal treatments for menopausal women with CKD.
Main Methods:
- Comprehensive literature review.
- Consensus reached through expert opinion.
Main Results:
- Menopause hormone therapy is a viable option for women with CKD.
- Treatment selection should prioritize patient preference and individual cardiovascular risk.
- Dosage adjustments for hormonal and non-hormonal therapies are necessary based on creatinine clearance.
Conclusions:
- Management of postmenopausal women with CKD requires a focus on lifestyle modifications and regular monitoring of cardiovascular risk factors and bone mineral density.
- Tailored, multidisciplinary care is crucial for women with comorbidities like diabetes, dyslipidemia, and hypertension.
- Osteoporosis management should be tailored to the specific stage of CKD.
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