Prescription of hormone replacement therapy in postmenopausal women with renal failure

Background. Although patients with end-stage renal disease (ESRD) are at in creased risk for early menopause, osteoporosis, cognitive dysfunction, and cardiovascular disease, few postmenopausal women are prescribed hormone rep lacement therapy (HRT). The reasons for the low prescription rate are not k nown. 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 a nd medical characteristics were abstracted from the database. Logistic regr ession was used to estimate the independent contribution of population char acteristics in predicting the use of HRT. Linear regression models were use d to estimate the relationship between HRT use and both triglycerides and t otal cholesterol. Results, The overall prevalence of HRT prescription was 10.8%. Important pr edictors of HRT use included age (aOR = 0.74, 95% CI 0.13 to 0.88, P < 0.00 1), black ethnicity (aOR = 0.50, 95% CI, 0.31 to 0.75, 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 a nd total cholesterol levels were higher among women treated with HRT than a mong those not treated with HRT (264 +/- 155 vs. 217 +/- 159 mg/dl, P = 0.0 01 and 220 +/- 62 vs. 209 +/- 55 mg/dl, P = 0.02. respectively). Conclusions. HRT is prescribed less frequently in postmenopausal ESRD patie nts than in the general population. Younger age, higher education levels, w hite 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.