TY  - JOUR
AB  - BACKGROUND: Both lower and higher estradiol (E2) levels have been associated with increased mortality among women with kidney failure. However, robust data are still lacking. OBJECTIVE: We investigated the interaction of diabetes and age on linear and nonlinear associations between E2 levels, adverse outcomes, and health-related quality of life (HRQOL) in Canadian women undergoing hemodialysis (HD). DESIGN: Population-based cohort study; data from Canadian Kidney Disease Cohort Study (CKDCS). SETTING & PATIENTS: A total of 427 women undergoing HD enrolled in the CKDCS. MEASUREMENTS: Baseline E2 (in pmol/L) and E2 tertiles (<38 pmol/L, 38-95 pmol/L, >95 pmol/L). METHODS: Cox-proportional hazards used for all-cause and cardiovascular disease (CVD) mortality. Fine-Gray models used for incident CVD. Mixed models used for Health Utilities Index Mark 3 (HUI3), Kidney Disease Quality of Life Physical Component Scores (KDQOL12-PCS), and Mental Component Scores (KDQOL12-MCS). RESULTS: Over a median follow-up of 3.6 (interquartile range [IQR]: 1.6-7.5) years, 250 (58.6%) participants died; 74 deaths (29.6%) were CV-related. Among 234 participants without prior CV events, 80 (34.2%) had an incident CVD event. There were no significant linear associations between E2 and all-cause mortality, CVD mortality, and incident CVD. However, E2 showed a significant concave association with all-cause mortality, but not with CVD mortality and incident CVD. Among patients aged ≥63 years, higher E2 levels were associated with lower HUI3 scores, mean difference (MD) = -0.062 per 1 - SD pmol/L, 95% confidence interval (CI) = -0.112 to -0.012, but the opposite was observed in younger patients (<63 years) in whom higher E2 levels were associated with higher HUI3 scores (MD = 0.032 per 1 - SD pmol/L, 95% CI = 0.008-0.055), Pinteraction = .045. No associations were observed among E2, KDQOL12-PCS (MD = -0.15 per 1 - SD pmol/L, 95% CI = -1.15 to 0.86), and KDQOL12-MCS (MD = -0.63 per 1 - SD pmol/L, 95% CI = -1.82 to 0.57). LIMITATIONS: Unmeasured confounding and small sample size. CONCLUSIONS: The association between E2 and all-cause mortality may be nonlinear, while no association was observed for CVD mortality, incident CVD, KDQOL12-PCS, and KDQOL12-MCS. Furthermore, the association between serum E2 and HUI3 was modified by age: Higher levels were associated with higher utility among women aged <63 years and the converse observed among older women.
AU  - Lau, L.H.Y.
AU  - Wiebe, N.*
AU  - Ramesh, S.*
AU  - Ahmed, S.*
AU  - Klarenbach, S.*
AU  - Carrero, J.J.*
AU  - Stenvinkel, P.*
AU  - Thorand, B.
AU  - Senior, P.*
AU  - Tonelli, M.*
AU  - Bello, A.K.*
C1  - 68722
C2  - 54931
CY  - 2455 Teller Rd, Thousand Oaks, Ca 91320 Usa
TI  - Associations of estradiol with mortality and health outcomes in patients undergoing hemodialysis: A prospective cohort study.
JO  - Can. J. Kidney Health Dis.
VL  - 10
PB  - Sage Publications Inc
PY  - 2023
SN  - 2054-3581
ER  -