Reproductive Health and Contraception in Females with Chronic Kidney Disease
Notice bibliographique
Résumé
Background: Chronic kidney disease (CKD) is a global epidemic that affects >13% of the population worldwide. Abnormal uterine bleeding is common in CKD, but most studies are limited to the kidney failure population. Abnormal menstruation is associated with cardiovascular risk, despite CKD already being a risk factor for cardiovascular disease. Pregnancy is known to be risky in CKD, therefore, contraception is paramount to prevent unplanned pregnancies in this reproductive-aged population; however, existing literature, though limited to the dialysis and transplant populations, has found that contraceptive use is low. Objectives: Using two separate yet complementary studies, we had multiple objectives. Project 1 aimed to describe self-assessed menstruation and contraceptive use among females across all stages of CKD using a global online survey. Project 2 aimed to (1) describe menstruation and changes in menstrual patterns with CKD progression, and (2) assess associations between reproductive hormones and menstrual patterns among females with kidney failure. Methods: In Project 1, females aged 18-50 years with a CKD diagnosis were invited to participate in an online survey. The survey was disseminated globally through 112 kidney organizations, patient groups, and social media. Whereas, in Project 2, females aged 18-50 years were recruited from dialysis clinics around Calgary, Alberta and completed a self-administered survey to capture demographic, kidney health, and menstrual health histories. Blood samples were also collected to measure the following reproductive hormone levels: follicle-stimulating hormone, luteinizing hormone, estradiol, progesterone, testosterone, prolactin, sex hormone binding globulin, and anti-Müllerian hormone. Results: Project 1 included 98 participants [n=20 dialysis (age 35±1 years), n=59 non-dialysis (age 32±1 years), n=19 transplant (age 35±2 years)]. One participant each in the dialysis and non-dialysis groups experienced primary amenorrhea, though more reported secondary amenorrhea (n=5 dialysis, n=9 non-dialysis, n=5 transplant). Of those experiencing current menses (n=14 dialysis, n=49 non-dialysis, n=14 transplant), 86%, 94%, and 100% of the dialysis, non-dialysis, and transplant groups reported heavy menstrual bleeding. Regarding, contraception, 50%, 63%, and 37% of dialysis, non-dialysis, and transplant participants reported no use, though among users, male condoms were notably popular in the dialysis (33%) and non-dialysis (48%) groups. Project 2 comprised of 27 females [n=23 hemodialysis (age 36 (IQR: 31,44) years), n=4 peritoneal dialysis (age 38 (IQR: 30,45) years)]. In the hemodialysis group, 52% reported absent menstrual bleeding during dialysis, though only 17% reported this during CKD and 9% before CKD diagnosis (p=0.01); however, there was no difference in proportions across timepoints in the peritoneal dialysis group. Further, in both groups, the prevalence of heavy menstrual bleeding was high, but did not differ throughout the progression of CKD. All the relevant hormone levels did not differ between those with absent and present menstrual bleeding, nor in those with heavy and normal menstrual bleeding. Conclusions: Together, these projects suggest that among the female CKD population, the prevalence of abnormal menstruation is high and contraception use is low, underscoring an important gap in the sex-specific care of this population. Given the lack of associations between hormone levels and menstrual status, we highlight the uncertainty around how kidney disease affects female reproductive health.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».