Introduction: Disturbances in menstruation and fertility are often reported in women with chronic kidney disease (CKD), particularly in women undergoing dialysis treatment (CKD stage 5). Prolactin (Prl) seems to play a major role in this pathomechanism. However, there are only very few data on the gonadal axis and the androgen status in postmenopausal women with mild to moderate renal failure and in dialysis patients. Therefore, we prospectively studied the sex hormone profile in such a patient cohort.
Methods: 197 female postmenopausal patients (median age:74 years, median. BMI: 28.6 kg/m2) in the CKD stages 15 and 38 patients on chronic hemodialysis (CHD=stage CKD 5D) were prospectively evaluated. Besides renal function and routine parameters (estimated Glomerular Filtration Rate (eGFR)), CRP, albumin, the following hormones were measured: DHEAS, Testosterone (T), SHBG, Estradiol (E2), LH, FSH and Prl. Free Androgen (FAI) and free Estrogen Index (FEI) were calculated.
Results: The mean eGFR was 33.7 ml/min (range 10140). The decrease in renal function from stage1 to 5 was associated (rho=−0.5; P< 0.001) with an increase in Prl from median 6.9 to 16.3 ng/ml (P<0.001). Prl was significantly higher in the CHD group (median: 20.5 ng/ml vs. 9.5 ng/ml; P< 0.001) in CKD patients. 9.3% had Prl values > 23.7 ng/ml in the CKD vs. 41% in the CHD patient group. LH and FSH were not affected by Prl. The androgens DHEAS and Testosterone as well as SHBG, FAI and FEI were unaffected by renal function. We found a negative correlation of BMI with SHBG (rho=−0.44; P<0.001), and a positive correlation for BMI with Testosterone (rho=0.18; P<0.012), FAI (rho=0.353; P<0.001) and with E2 (rho=0.2; P<0.006). E2, however, was significantly higher in the CHD group (median 21.7 vs. 11.7 pg/ml; P<0.001) and positively correlated with CRP (rho=0.502; P<0.002).
Summary: The decline in renal function from CKD stage 1 to 5 in postmenopausal women is mainly associated with an increase in Prl. Testosterone and FAI are independent from renal function but positively associated with BMI and negatively correlated with SHBG values. The significant higher E2 concentrations in patients undergoing hemodialysis are correlated with a higher inflammation status and most likely due to enhanced aromatization from Testosterone.
18 - 21 May 2019
European Society of Endocrinology