Objective To evaluate the associations between serum uric acid (SUA) levels and estimated glomerular filtration rate (eGFR) and chronic kidney disease (CKD), with a focus on gender differences, and variations among women pre-and post-menopausal stages. Design A retrospective cohort study. Setting A large community-based survey was conducted every two years from 2010 to 2018 in Hangzhou, Zhejiang Province, Southeastern China. Participants 10,218 participants (40 years or above) without CKD at baseline who underwent three physical examinations were enrolled. CKD was defined as an eGFR of less than 60 mL/min/1.73m2. Methods Participants with SUA levels were divided into four groups (Q1-Q4) based on baseline SUA quartiles. The Q1 was the reference. By stratifying participants by gender, the relationships between SUA levels and eGFR were investigated using the generalized additive mixture model. The associations of SUA and the risk of incident CKD were examined using multivariate logistic regression models in the generalized estimating equation. Results After adjusting for confounding variables, a nonlinear association between SUA and eGFR was observed in females, while an approximately linear relationship was observed in males, suggesting that elevated SUA levels are associated with renal function decline. Furthermore, the highest quartile of SUA was associated with a 2.16-fold (95% CI: 1.31–3.58) increased risk of CKD in males and a 2.76-fold (95% CI: 1.59–4.78) increased risk in females, compared with the lowest quartile. And the spline curves demonstrated a U-shaped pattern, suggesting a potential threshold effect of SUA on the risk of CKD. Additionally, Subgroup analyses revealed significant associations between elevated SUA levels with CKD in postmenopausal women, but not in premenopausal women. Conclusion Elevated SUA levels are associated with an increased risk of CKD development and renal function decline in middle-aged and elderly individuals, particularly in postmenopausal women.

Serum Uric Acid Levels and Their Association with Renal Function Decline and Kidney Disease Progression in Middle-Aged and Elderly Populations: A Retrospective Cohort Study

BACKGROUND. The influence of female sex hormones on the regulation of the processes of formation and resorption of bone tissue, as well as the effect of excess or deficiency of sex hormones on renal function is associated with the development of cardiovascular complications in patients at different stages of chronic kidney disease. THE AIM : to study the relationship between estradiol deficiency and excess FSH content with disorders of mineral and bone metabolism and cardiovascular complications in postmenopausal women on hemodialysis. PATIENTS AND METHODS. 119 women from 34 to 57 years old on hemodialysis were examined. The concentration of follicle-stimulating hormone (FSH) and estradiol2, sclerostin, and fibroblast growth factor 23 (FGF-23) was determined using a sandwich-variant solid-phase ELISA on a «Multiscan EX analyzer» («ThermoFisher Scientific Inc.», Finland) with kits of «Alkor-Bio Company» (Russian Federation) and sets of "sandwich" type manufactured by Cloud-Clone Corp., USA. Echocardiography was performed using an «ALOKA 4000 Aplio» (Toshiba, Japan) in Doppler mode. Determined the left ventricular ejection fraction (LVEF), peak systolic velocity in the aortic arch (Vps – peak systolic velocity); LV myocardial mass index (LVMI). Left ventricular hypertrophy (LVH) was defined with LVMI greater than 95 g /m 2 in women. RESULTS. There was a direct correlation between high levels of FSH and high levels of sclerostin, FSH, and FGF23, an inverse correlation between low levels of estradiol2 and sclerostin, estradiol2 and FGF23, expressed in groups of patients with more severe changes in LVMI and Vps. CONCLUSION. In women on hemodialysis, bone mineral and cardiovascular abnormalities are associated with both renal failure proper and changes in the system of female sex hormones. A decrease in estradiol levels causes an increase in the nephrotoxic FSH and contributes to the excessive synthesis of sclerostin, a key factor in bone-mineral and cardiovascular complications in CKD. 

Estradiol and follicle-stimulating hormone imbalance associated with mineral-bone metabolism disturbances and cardiovascular complications in women on hemodialysis

The phenomenon of low testosterone level is extremely common in male patients with chronic kidney diseases (CKDs). This meta-analysis aimed to evaluate whether the low circulating testosterone could independently predict adverse outcomes among male patients with chronic kidney diseases (CKDs). The data till May 2022 were systematically searched from Pubmed, Web of Science, and Embase from inception. Studies meeting the PICOS (population, intervention/exposure, control/comparison, outcomes, and study design) principles were included in this meta-analysis. Study-specific effect estimates were pooled using fixed-effects (I2 > 50%) or random-effects models (I2 < 50%). Ultimately, 9 cohort studies covering 5331 patients with CKDs were involved in this meta-analysis. The results suggested that per 1-standard deviation (SD) decrease in total testosterone independently increased the risk of all-cause mortality by 27% [hazard risk (HR) 1.27, 95% confidence interval (CI) 1.16–1.38], cardiovascular mortality by 100% (HR 2.00, 95% CI 1.39–2.86), cardiovascular events by 20% (HR 1.20, 95% CI 1.04–1.39), and infectious events by 41% (HR 1.41, 95% CI 1.08–1.84). Besides, with per 1-SD decrease in free testosterone, the risk of overall adverse events increased by 66% (HR 1.66, 95% CI 1.34–2.05). Stratified analyses indicated that the negative relationship of the total testosterone with all-cause death risk was independent of factors involving age, race, body mass index, diabetes, hypertension, C-reactive protein, creatinine, and sex hormone binding globulin. In conclusion, it was identified that low endogenous testosterone could serve as an independent predictor of adverse clinical events among male patients with CKDs.

/pdf/low-testosterone-level-and-risk-of-adverse-clinical-events-i1ucr22n.pdf

Low Testosterone Level and Risk of Adverse Clinical Events among Male Patients with Chronic Kidney Disease: A Systematic Review and Meta-Analysis of Cohort Studies

Abstract Introduction: Chronic kidney disease (CKD) and metabolic syndrome (MS) are recognized as public health problems which are related to overweight and cardiometabolic factors. The aim of this study was to develop a model to predict MS in people with CKD. Methods: This was a prospective cross-sectional study of patients from a reference center in São Luís, MA, Brazil. The sample included adult volunteers classified according to the presence of mild or severe CKD. For MS tracking, the k-nearest neighbors (KNN) classifier algorithm was used with the following inputs: gender, smoking, neck circumference, and waist-to-hip ratio. Results were considered significant at p < 0.05. Results: A total of 196 adult patients were evaluated with a mean age of 44.73 years, 71.9% female, 69.4% overweight, and 12.24% with CKD. Of the latter, 45.8% had MS, the majority had up to 3 altered metabolic components, and the group with CKD showed statistical significance in: waist circumference, systolic blood pressure, diastolic blood pressure, and fasting blood glucose. The KNN algorithm proved to be a good predictor for MS screening with 79% accuracy and sensitivity and 80% specificity (area under the ROC curve – AUC = 0.79). Conclusion: The KNN algorithm can be used as a low-cost screening method to evaluate the presence of MS in people with CKD.

Prediction of metabolic syndrome and its associated risk factors in patients with chronic kidney disease using machine learning techniques

Objective: Menopause contributes to renal dysfunction in women and it is generally attributed to oestrogen withdrawal. In addition to decreased oestrogen levels, serum follicle-stimulating hormone (FSH) levels also increase substantially after menopause. We investigated the association between high circulating FSH levels and renal function in postmenopausal women. Methods: This was an observational cross-sectional study included 624 pre-menopausal, 121 peri-menopausal, and 2540 postmenopausal women. The levels of female sex hormones were examined by chemiluminescent methods and the indices of renal function were examined using a Beckman AU5800 Chemistry analyser system. The main analyses assessed postmenopausal women divided by serum FSH quartiles. Results: Comparisons among women from pre-menopause to peri-menopause to post-menopause showed obvious stepwise recessions in renal function had accompanied by increasing serum FSH levels. In postmenopausal women, with increasing FSH quartiles, the serum creatinine (Scr) levels gradually increased, corresponding with the gradual decrease in the estimated glomerular filtration rate (eGFR) (p for trend < 0.001); moreover, both the prevalence of declined eGFR (eGFR < 90 ml/min/1.73 m2) and chronic kidney disease (CKD, eGFR < 60 ml/min/1.73 m2) gradually increased (p for trend < 0.001). Even after adjusting for vital confounders, both odds ratios (ORs) of decreased eGFR and CKD increased with increasing FSH quartiles. The ORs of declined eGFR (OR = 2.19, 95% CI: 1.63–2.92) and CKD (OR = 10.09, 95% CI: 2.28–44.65) in the highest quartile of FSH increased approximately twofold and tenfold compared with that in the lowest quartile (p < 0.05), respectively. After stratifying postmenopausal women by median age (61 years), the OR of decreased eGFR for each FSH quartile in the older group was higher than that for the corresponding FSH quartile in the younger group. Conclusions: A high circulating FSH level was an independent risk factor for renal dysfunction in women after menopause and the adverse effects of FSH on renal function worsened with ageing. Key words: FSH, menopause, eGFR, CKD, renal dysfunction, ageing

/pdf/high-circulating-follicle-stimulating-hormone-level-is-a-2bg04v999q.pdf

High Circulating Follicle-Stimulating Hormone Level Is a Potential Risk Factor for Renal Dysfunction in Post-Menopausal Women.

Introduction : Despite advances in the management of chronic kidney disease (CKD), there is ongoing uncertainty regarding the prevalence of CKD in postmenopausal women. This study was designed to investigate both CKD prevalence and related risk factors in a cohort of postmenopausal Chinese women. Materials and Methods : A cross‑sectional survey was administered to a nationally representative sample of female Chinese participants, including a total of 47,204 subjects, among whom were 8573 self‑reported postmenopausal women. CKD was defined as either an estimated glomerular filtration rate (eGFR) of 1). Conclusion : The current study revealed a high prevalence of CKD in Chinese postmenopausal women. These results provide baseline data for disease prevention and treatment. Key words : Albuminuria, Chinese postmenopausal women, chronic kidney disease, creatinine, cross‑sectional survey, glomerular filtration rate

/pdf/chronic-kidney-disease-in-chinese-postmenopausal-women-a-zql9badwie.pdf

Chronic kidney disease in Chinese postmenopausal women: A cross-sectional survey.

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Chronic kidney disease in Chinese postmenopausal women: A cross-sectional survey.