Kidney Week

Abstract: FR-PO210

Estradiol and Renal and Cardiovascular Outcomes in Women with CKD: The Chronic Renal Insufficiency Cohort (CRIC) Study

Session Information

• CKD: Epidemiology, Risk Factors, Prevention - II
  October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 1901 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Ricardo, Ana C., University of Illinois at Chicago, Chicago, Illinois, United States

Ana C. Ricardo,

• Kim, Catherine, University of Michigan, Ann Arbor, Michigan, United States

Catherine Kim,

• Hsu, Jesse Yenchih, University of Pennsylvania, Philadelphia, Pennsylvania, United States

Jesse Yenchih Hsu,

• Carmona, Eunice, University of Illinois at Chicago, Chicago, Illinois, United States

Eunice Carmona,

• Anderson, Amanda Hyre, University of Pennsylvania, Philadelphia, Pennsylvania, United States

Amanda Hyre Anderson,

• Chen, Jing, Tulane School of Medicine, New Orleans, Louisiana, United States

Jing Chen,

• Dobre, Mirela A., Case Western Reserve University, Cleveland, Ohio, United States

Mirela A. Dobre,

• Kusek, John W., NIDDK, Bethesda, Maryland, United States

John W. Kusek,

• Krousel-wood, Marie, Ochsner Clinic Foundation, New Orleans, Louisiana, United States

Marie Krousel-wood,

• Parikh, Nikhil Ashwin, University of Illinois at Chicago, Chicago, Illinois, United States

Nikhil Ashwin Parikh,

• Steigerwalt, Susan P., University of Michigan, Ann Arbor, Michigan, United States

Susan P. Steigerwalt,

• Wang, Xue, University of Pennsylvania, Philadelphia, Pennsylvania, United States

Xue Wang,

• Feldman, Harold I., University of Pennsylvania, Philadelphia, Pennsylvania, United States

Harold I. Feldman,

• Lash, James P., University of Illinois at Chicago, Chicago, Illinois, United States

James P. Lash,

Background

The incidence of end-stage renal disease (ESRD) and cardiovascular disease is lower in women than men. This observation may be explained by the protective effect that endogenous estrogens may have on vascular function. We evaluated the association of estradiol levels with renal and cardiovascular outcomes in women with chronic kidney disease (CKD).

Methods

Prospective, longitudinal study of 1125 women with measured plasma 17b-estradiol by electrochemiluminescent immunoassay at the second annual CRIC visit. We used multivariable mixed-effects and Cox models to examine the association of estradiol with estimated glomerular filtration rate (eGFR) slope, incident ESRD (dialysis or transplantation), atherosclerotic events (myocardial infarction/revascularization, stroke or peripheral arterial disease) and all-cause mortality.

Results

Overall mean (SD) age was 59.6 (10.9) years, and median (IQR) estradiol level 15.8 (8.5-30.2) pg/mL. Compared with women in the highest estradiol quartile (Q4), women in the lowest quartile (Q1) were more likely to be older (63.0 vs. 50.0 years), non-Hispanic white (56.8 vs. 37.4%), and post-menopausal (96.5 vs. 44.2%); and less likely to have diabetes (36.8 vs. 45.9%) and obesity (39.6 vs. 54.1%). Mean eGFR in ml/min/1.73m² was higher in Q1 (46.9) compared with Q4 (45.9). Median urine protein-creatinine ratio was similar in the two quartiles (0.09 vs. 0.10). Over a median follow-up of 6.9 years, 189 women developed ESRD, 121 had an atherosclerotic event, and 165 died. In mixed effects models adjusted for relevant demographic and clinical characteristics, the difference in eGFR slope between Q1 and Q4 was 0.34 ml/min/1.73m²/year (p=0.5). We found no significant association between estradiol (Q1 vs. Q4) and ESRD (HR 0.61, 95% CI 0.35-1.09), atherosclerotic events (HR 0.59, 95% CI 0.29-1.19) or death (HR 0.75, 95% CI 0.4-1.41). The results were unchanged in analyses stratified by menopausal status.

Conclusion

In this cohort of women with CKD, estradiol levels were not associated with renal outcomes, cardiovascular events or death.

Funding

• NIDDK Support