Sex hormones and the risk of cardiovascular disease and mortality in male and female patients with chronic kidney disease: A systematic review and meta-analysis.
Sex hormones and the risk of cardiovascular disease and mortality in male and female patients with chronic kidney disease: A systematic review and meta-analysis.
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DOI：
10.14814/phy2.15490
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发表时间：
2022-11
影响因子：
2.5
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中科院分区：
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慢性肾脏病 (CKD) 患者通常会出现性激素紊乱，这可能与心血管疾病 (CVD) 和死亡风险相关。本综述旨在系统评估 CKD 人群中性激素水平与 CVD 事件和死亡率（CVD 和全因）风险之间关系的最新研究结果。在 CINAHL、Cochrane 和 PubMed 中系统地检索了文章。共有1739篇文章由两名评审员独立筛选，纳入17项前瞻性队列研究。患者的临床状况为非透析 CKD 患者[平均/中位估计肾小球滤过率 (eGFR) 在 15-51ml/min/1.73m2 之间]和慢性透析患者（平均/中位肾小球滤过率在 6-125 个月之间）。样本量范围为 111 至 2419 人，受试者的平均/中位年龄范围为 52 至 72 岁。研究的性激素是睾酮、雌二醇、催乳素、硫酸脱氢表雄酮和松弛素。使用随机效应模型生成汇总风险比 (HR)，以评估总睾酮水平与 CVD 和全因死亡率风险的关联。大多数研究检查了总睾酮水平（17 项研究中的 11 项）并且仅研究男性患者（17 项研究中的 12 项）。在患有 CKD 的男性中，较低的总睾酮水平与较高的 CVD 死亡风险 [HR 4.37 (95% CI 1.40–13.65)] 和全因死亡率 [1.96 (1.35–2.83)] 相关。总而言之，强烈需要进行更多研究来检验性激素与女性 CKD 患者心血管和死亡风险的关系。慢性肾病患者通常会出现性激素紊乱，这可能与心血管疾病和死亡的风险有关。在当前的系统评价中，我们发现大多数研究检查了总睾酮水平（17 项研究中的 11 项）并且仅研究男性患者（17 项研究中的 12 项）。患有 CKD 的男性中，较低的总睾酮水平与较高的 CVD 风险和全因死亡率相关。强烈需要进行更多研究来检查性激素与女性 CKD 患者心血管和死亡风险的关系。
Patients with chronic kidney disease (CKD) commonly experience sex hormone disturbances, which may be associated with the risk of cardiovascular disease (CVD) and mortality. This review aimed to systematically evaluate current findings on the association of sex hormone levels with the risk of CVD events and mortality (CVD and all‐cause) in the CKD population. Articles were systematically searched in CINAHL, Cochrane, and PubMed. A total of 1739 articles were independently screened by two reviewers and 17 prospective cohort studies were included. The clinical conditions of the patients were those with non‐dialysis CKD [mean/median estimated glomerular filtration rate (eGFR) between 15–51 ml/min/1.73 m2] and those on chronic dialysis (mean/median vintage between 6–125 months). The sample size ranged from 111 to 2419 and the mean/median age of subjects ranged from 52 to 72 years. The sex hormones studied were testosterone, estradiol, prolactin, dehydroepiandrosterone sulfate, and relaxin. A random‐effects model was used to generate a pooled hazard ratio (HR) to evaluate the association of total testosterone levels with the risk of CVD and all‐cause mortality. Most studies examined total testosterone levels (11 out of 17 studies) and studied only male patients (12 out of 17 studies). A lower total testosterone level was associated with a higher risk of CVD mortality [HR 4.37 (95% CI 1.40–13.65)] and all‐cause mortality [1.96 (1.35–2.83)] in males with CKD. To conclude, there is a strong need for additional studies examining the association of sex hormones with cardiovascular and mortality risk in female patients with CKD. Patients with chronic kidney disease commonly experience sex hormone disturbances, which may be associated with the risk of cardiovascular disease and mortality. In the current systematic review, we found most studies examined total testosterone levels (11 out of 17 studies) and studied only male patients (12 out of 17 studies). A lower total testosterone level was associated with a higher risk of CVD and all‐cause mortality in males with CKD. There is a strong need for additional studies examining the association of sex hormones with cardiovascular and mortality risk in female patients with CKD.