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Abstract: TH-PO727

The Effect and Safety of Postmenopausal Hormone Therapy and Selective Estrogen Receptor Modulators on Kidney Outcomes in Women: A Systematic Review

Session Information

Category: Women’s Health and Kidney Diseases

  • 2000 Women’s Health and Kidney Diseases

Authors

  • Dumanski, Sandi M., University of Calgary, Calgary, Alberta, Canada
  • Ramesh, Sharanya, University of Calgary, Calgary, Alberta, Canada
  • James, Matthew T., University of Calgary, Calgary, Alberta, Canada
  • Metcalfe, Amy, University of Calgary, Calgary, Alberta, Canada
  • Nerenberg, Kara A., University of Calgary, Calgary, Alberta, Canada
  • Robertson, Helen Lee, University of Calgary, Calgary, Alberta, Canada
  • Ahmed, Sofia B., University of Calgary, Calgary, Alberta, Canada
Background

The number of postmenopausal women with or at risk of chronic kidney disease (CKD) is increasing exponentially. The benefits and risks of postmenopausal hormone therapy (PHT) and selective estrogen receptor modulators (SERMs) on kidney health outcomes in these women are poorly understood. This systematic review aimed to: 1) determine the effects of PHT and SERMs on kidney function and albuminuria in women, and, 2) characterize the risk of adverse outcomes of PHT and SERMs in the CKD population, who are already at an increased risk of venous thromboembolism and malignancy.

Methods

An electronic literature search was completed using a peer reviewed search strategy in MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials. We searched published studies (1950- December 2018) examining the effect of PHT and SERMs on kidney function and albuminuria, and adverse outcomes in women with CKD. Two independent investigators screened identified citations examining the effect of PHT and SERMs on kidney outcomes in the general population of women, as well as adverse outcomes in the CKD population. Data was independently extracted from each eligible study, and the risk of bias was assessed. Results were synthesized in a descriptive manner.

Results

A total of 3,078 references were screened, and 18 studies met eligibility criteria. Compared with no treatment, use of PHT was associated with improved kidney function and unchanged or reduced proteinuria in more than 60% of studies that addressed this question. No studies were identified that reported on the safety of PHT in women with CKD. Studies addressing the effects of SERMs on kidney function were conflicting, with 2 studies reporting increased kidney function and reduced proteinuria, and another reporting decreased kidney function. Based on results from 2 small studies, SERMs did not have any increased risk of venous thromboembolism in women with CKD compared to placebo.

Conclusion

Existing studies suggest that PHT and SERMs are associated with improved kidney function, with no increase in albuminuria. Safety data in the CKD population is lacking. Available studies had significant limitations and heterogeneity, highlighting the need for rigorous prospective studies examining the effect of PHT and SERMs on kidney function, and their safety in CKD.