Prescription of hormone replacement therapy in postmenopausal women with renal failure.
Prescription of hormone replacement therapy in postmenopausal women with renal failure.


BACKGROUND
Although patients with end-stage renal disease (ESRD) are at increased risk for early menopause, osteoporosis, cognitive dysfunction, and cardiovascular disease, few postmenopausal women are prescribed hormone replacement therapy (HRT). The reasons for the low prescription rate are not known. This study uses data from the United States Renal Data System (USRDS) to assess the prevalence and predictors of HRT use in postmenopausal women with ESRD.


METHODS
Data were obtained from the USRDS Dialysis Morbidity and Mortality Study Wave 2. All women who were at least 45 years of age were considered postmenopausal and were selected for our analysis. Demographics, behavior and medical characteristics were abstracted from the database. Logistic regression was used to estimate the independent contribution of population characteristics in predicting the use of HRT. Linear regression models were used to estimate the relationship between HRT use and both triglycerides and total cholesterol.


RESULTS
The overall prevalence of HRT prescription was 10.8%. Important predictors of HRT use included age (aOR = 0.74, 95% CI 0.13 to 0.88, P < 0.001), black ethnicity (aOR = 0.50, 95% CI, 0.31 to 0.78, P < 0.002), college education (aOR = 3. 00, 95% CI, 1.70 to 5.24, P < 0.001), and the ability to ambulate (aOR = 1.99, 95% CI, 1.01 to 3.91, P = 0.05). Serum triglyceride and total cholesterol levels were higher among women treated with HRT than among those not treated with HRT (264 +/- 155 vs. 217 +/- 159 mg/dl, P = 0.001 and 220 +/- 62 vs. 209 +/- 55 mg/dl, P = 0.02, respectively).


CONCLUSIONS
HRT is prescribed less frequently in postmenopausal ESRD patients than in the general population. Younger age, higher education levels, white race, and the ability to ambulate were important predictors of HRT use. Targeting populations of patients who are likely to benefit from but less likely to be prescribed HRT may increase the prescription of HRT.
Stehman-Breen
C O
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Department of Biostatistics, University of Washington, Seattle, Washington, USA. cos@u.washington.edu
Gillen
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Gipson
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D000368:Aged; D002784:Cholesterol / Q000097:blood; D005260:Female; D020249:Hormone Replacement Therapy / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy / Q000517:prevention & control; D010530:Peritoneal Dialysis; D017698:Postmenopause; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000150:complications / Q000628:therapy*; D014280:Triglycerides / Q000097:blood; D014481:United States
D014280:Triglycerides; D002784:Cholesterol