Women with CKD experience menstrual abnormalities, shorter reproductive lifespans
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Women with chronic kidney disease may experience menstrual abnormalities and shorter reproductive lifespans compared with those without CKD, according to data in the Clinical Journal of the American Society of Nephrology.
Further, kidney transplantation may improve menstrual health among this population.
“As female reproductive health is associated with important nonreproductive health outcomes, including mortality, this underscores the importance of understanding the prevalence of menstrual abnormalities and the reproductive lifespan in the CKD population,” Chantal L. Rytz, MS, a PhD student from University of Calgary in Canada, and colleagues wrote. “Therefore, the objective of this systematic review and meta-analysis was to determine the prevalence of menstrual abnormalities and quantify the reproductive lifespan of females with CKD.”
In a systematic review and meta-analysis, researchers identified all articles reporting on women of reproductive age with “nondialysis-dependent/nonkidney transplant CKD,” dialysis-dependent CKD, or kidney transplantation and menstruation patterns, age of menarche and/or menopause. Data between database inception and February 2022 were derived from MEDLINE, Embase, and Cumulative Index to Nursing and Allied Health Literature. Researchers conducted duplicate data extraction and study quality assessments and used a random effects meta-analysis to derive pooled proportions estimates.
A total of 46 articles were included in the final analysis, which consisted of 5,636 patients. The reproductive lifespan was 32 years. Researchers identified menstrual abnormalities in 19% to 47% of patients on hemodialysis and 75% of patients on peritoneal dialysis. Additionally, kidney transplantations correlated with a 7% to 30% decline in menstrual abnormalities.
“Although our findings indicate that the pooled average age of menarche of 13 years is similar to the general population, the pooled average age of menopause of 47 years and the reproductive lifespan of 32 years are considerably shorter,” Rytz and colleagues wrote.
Researchers noted significant heterogeneity, a range of fair to good quality studies and no evidence of publication bias.
“Menstrual disorders are common in females with CKD and are more than a reproductive health issue, with implications for quality of life and socioeconomic status. These sex-specific factors of women are associated with cardiovascular and bone health, as well as malignancy risk in the general population; whether these same associations exist in the CKD population is unknown,” Rytz and colleagues wrote. “This lack of data precludes guidance in this key aspect of care of female patients across the stages of CKD and represents an important knowledge gap in nephrology.”
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