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Associations of estradiol with mortality and health outcomes in patients undergoing hemodialysis: A prospective cohort study.
Can. J. Kidney Health Dis. 10:20543581231209233 (2023)
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.
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Publication type
Article: Journal article
Document type
Scientific Article
Keywords
All-cause Mortality ; Cardiovascular Mortality ; Diabetes ; Estradiol ; Health-related Quality Of Life ; Hemodialysis; Quality-of-life; Chronic Kidney-disease; Sex-differences; Cardiovascular-disease; Postmenopausal Women; Hormone-therapy; Estrogen; Premenopausal; Replacement; Guidelines
ISSN (print) / ISBN
2054-3581
e-ISSN
2054-3581
Quellenangaben
Volume: 10,
Article Number: 20543581231209233
Publisher
Sage
Publishing Place
2455 Teller Rd, Thousand Oaks, Ca 91320 Usa
Non-patent literature
Publications
Reviewing status
Peer reviewed
Institute(s)
Institute of Epidemiology II (EPI2)
Grants
The authors of this report are grateful to the study coordinators (Sue Szigety, Nasreen Ahmad, Coralea Bignell, Edita Delic, Sharon Gulewich, Julie Leidecker, Lorena McCoshen, Lisa McFaull, Mary Morgen, Nancy Ruholl, Rafael Sibrian, Charlynn Ursu, Gwen Wi