Estrogen replacement therapy: implications for postmenopausal women with end-stage renal disease

Little information is available about either the potential beneficial or ha rmful effects of estrogen replacement therapy in postmenopausal women with end-stage renal disease, Although evidence supports a role for estrogen rep lacement therapy in postmenopausal women in the prevention of cardiovascula r disease and bone loss, possible improvement in cognitive function, and th e relief of menopausal symptoms, these conclusions may not be applicable to patients with end-stage renal disease, since these studies have generally excluded such women, This issue is of considerable importance since cardiov ascular causes account far more than 50% of the all-cause mortality in pati ents with end-stage renal disease. However, estrogen replacement therapy ma y also have untoward effects in patients with the disease, including an inc reased risk of dialysis access thrombosis and potentially worsening coronar y artery disease in postmenopausal patients. Furthermore, dosing of estroge ns needs to be done carefully since renal excretion is important for the el imination of estrogen metabolites. Low dose or alternate day dosing in addi tion to monitoring estrogen levels may be warranted when prescribing estrog en replacement therapy to women with end-stage renal disease. In this revie w, it is our objective to analyze the evidence published in the literature so far and to weigh the risks and benefits of estrogen therapy in postmenop ausal women with end-stage renal disease, Curr Opin Nephrol Hypertens 9:207 -214, (C) 2000 Lippincott Willlams & Wilkins.