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Relation between serum estradiol levels and mortality in postmenopausal female hemodialysis patients

  • Nephrology – Original Paper
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Abstract

Background

Recently, low serum estradiol levels have been associated with increased cardiovascular risk and mortality in non-uremic patient populations. We investigated the predictive value of serum estradiol levels for mortality in female hemodialysis patients.

Methods

One hundred and forty-seven prevalent female hemodialysis patients were included in March 2005 and followed up for 32 ± 16 months. Serum estradiol levels were determined by ELISA at baseline and studied in relation to cardiovascular and overall mortality.

Results

Mean serum estradiol level was 28.6 ± 15.4 pg/ml (5.7–81.3). Patients in the higher estradiol tertile were likely to be more often diabetic and to have more cardiovascular diseases and higher body mass index (BMI). Serum estradiol was inversely correlated with age and urea reduction rate and positively correlated with postdialysis body weight, BMI and hs-CRP levels. During the follow-up period, 52 (35.6 %) patients died. Patients who died were older, had shorter dialysis vintage, were more likely to have a history of diabetes and cardiovascular disease, and lower serum creatinine, albumin, hemoglobin, and higher hs-CRP levels than those who survived. In Cox regression analysis, estradiol levels, in a bimodal (U-shaped) distribution, along with diabetes, low serum albumin and high hs-CRP levels, were predictors for overall mortality.

Conclusions

A U-shaped association between serum estradiol levels and cardiovascular and overall mortality was found in postmenopausal hemodialysis patients.

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Acknowledgments

The authors would like to thank all staff of the participating hemodialysis centers for their help and support.

Conflict of interest

The study was supported by Fresenius Medical Care, Turkey with an unrestricted grant. M.T. has worked as a physician at a Fresenius Medical Care Clinic in the last 2 years, and EO is a member of the scientific advisory board of Fresenius Medical Care, Turkey.

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Authors and Affiliations

  1. Division of Nephrology, Izmir Tepecik Research and Training Hospital, Izmir, Turkey

    Mehmet Tanrisev

  2. Division of Nephrology, Ege University School of Medicine, Izmir, Turkey

    Gulay Asci, Ozkan Gungor, Fatih Kircelli, Ebru Sevinc Ok, Mumtaz Yilmaz, Huseyin Toz & Ercan Ok

  3. Division of Nephrology, Ataturk Research and Training Hospital, Izmir, Turkey

    Osman Z. Sahin & Kezban Pinar Ozen

  4. Division of Nephrology, Akdeniz University School of Medicine, Antalya, Turkey

    Gultekin Suleymanlar

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  1. Mehmet Tanrisev
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  2. Gulay Asci
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Correspondence to Mehmet Tanrisev.

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Tanrisev, M., Asci, G., Gungor, O. et al. Relation between serum estradiol levels and mortality in postmenopausal female hemodialysis patients. Int Urol Nephrol 45, 503–510 (2013). https://doi.org/10.1007/s11255-012-0171-7

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  • DOI: https://doi.org/10.1007/s11255-012-0171-7

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