Abstract
BackgroundThe prevalence of menopause in women with or at risk of chronic kidney disease is increasing globally. Although international guidelines on menopause recommend the use of postmenopausal hormone therapy with or without selective estrogen receptor modulators for control of vasomotor symptoms, the effects of these treatments on kidney function and albuminuria are unclear. Furthermore, women with chronic kidney disease are at significantly increased risk of venous thromboembolism and malignancy, well-documented adverse effects of postmenopausal hormone therapy. Our study aims to establish the effect of these treatments on kidney function and albuminuria in women, as well as determine the safety of these treatments in the chronic kidney disease population.MethodsWe will conduct a systematic review and meta-analysis addressing the effect and safety of postmenopausal hormone therapy and selective estrogen receptor modulators on kidney outcomes in women. We plan to search for published (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), tables of contents of relevant journals) and unpublished (ongoing studies, conference proceedings) studies in all languages examining the effect of postmenopausal hormone therapy, including selective estrogen receptor modulators, on kidney function and albuminuria, as well as the risk of adverse outcomes of these treatments in women with chronic kidney disease. Two independent investigators will screen identified abstracts and select studies that examine the effect of postmenopausal hormone therapy and selective estrogen receptor modulators on kidney outcomes in the general population or adverse outcomes in the chronic kidney disease population. Data on study population, intervention, outcomes, as well as study quality and risk of bias will be independently extracted from each eligible study. Along with descriptive presentation of data, outcome measures will be presented as meta-analyses using a random effects model. Planned subgroup analyses will be completed, and meta-regression will be performed if significant heterogeneity is noted.DiscussionBy examining the effects of postmenopausal hormone therapy and selective estrogen receptor modulators on kidney function and albuminuria, the results of this systematic review and meta-analysis will inform management of postmenopausal women in the general population. Furthermore, it will evaluate the safety, including the risks of known adverse outcomes of postmenopausal hormone therapy and selective estrogen receptor modulators, in the already vulnerable chronic kidney disease population.Systematic review registrationPROSPERO CRD42016050651
Highlights
The prevalence of menopause in women with or at risk of chronic kidney disease is increasing globally
One of the reasons behind these discrepant results may lie in the fact that none of these meta-analyses reported on the use of postmenopausal hormone therapy (HT) or selective estrogen receptor modulator (SERM), which may have potential effects on kidney outcomes
These findings suggest that the estrogen component of postmenopausal HT may play a beneficial role with respect to kidney function, though the effect of postmenopausal HT and SERMs on human kidney function is not yet established
Summary
The prevalence of menopause in women with or at risk of chronic kidney disease is increasing globally. International guidelines on menopause recommend the use of postmenopausal hormone therapy with or without selective estrogen receptor modulators for control of vasomotor symptoms, the effects of these treatments on kidney function and albuminuria are unclear. Though the complexity of the physiologic and clinical interaction between female sex hormones and kidney function remains poorly understood, animal data report a renoprotective role for estrogen [22,23,24,25,26,27] These findings suggest that the estrogen component of postmenopausal HT may play a beneficial role with respect to kidney function, though the effect of postmenopausal HT and SERMs on human kidney function is not yet established
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