Selective estrogen receptor modulators in chronic renal failure.
BACKGROUND
In addition to renal osteodystrophy, postmenopausal women on dialysis could be at risk of osteoporosis. Hormone replacement therapy (HRT) could have beneficial effects as well as potentially serious risks, especially in uremic women, due to the pharmacokinetics of estradiol in renal failure. Therapeutic alternatives, such as the selective estrogen receptor modulators (SERMs), have shown the benefits of estrogen on bone and serum lipid levels, without its adverse effects on the breast and endometrium, in nonuremic women.


METHODS
Recent data on the effect of the SERM raloxifene in bone and lipid metabolism in osteoporotic postmenopausal women on dialysis is reviewed. Since the estrogen receptor (ER) gene has been suggested as a candidate marker for osteoporosis, we investigated whether ER polymorphism could have predicted the BMD response to raloxifene.


RESULTS
Hemodialyzed women on raloxifene demonstrated increased trabecular bone mineral density (BMD) and decreased bone resorption markers. Similarly, LDL-cholesterol values dropped significantly. ER gene polymorphism analysis of baseline BMD parameters did not differ between PP/xx or Pp/Xx groups. Nevertheless, patients on raloxifene with PP/xx genotypes, but not those with Pp/Xx, showed a higher trabecular BMD after one year on treatment, suggesting that homozygous women for P or x alleles of the ER have a better BMD response to raloxifene.


CONCLUSIONS
Raloxifene and, most likely, other SERMs, could represent a good alternative to HRT in postmenopausal uremic women.
Weisinger
José R
JR
Division of Nephrology, Hospital Universitario de Caracas, Universidad Central de Venezuela, Caracas, Venezuela. jweising@telcel.net.ve
Heilberg
Ita Pfeferman
IP
Hernández
Eddy
E
Carlini
Raul
R
Bellorin-Font
Ezequiel
E
D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000473:pathology / Q000517:prevention & control*; D004967:Estrogens / Q000502:physiology; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D015663:Osteoporosis, Postmenopausal / Q000473:pathology / Q000517:prevention & control; D020845:Selective Estrogen Receptor Modulators / Q000627:therapeutic use*
D004967:Estrogens; D020845:Selective Estrogen Receptor Modulators