Women's Health Risks and Chronic Kidney Disease

More women being diagnosed with chronic kidney disease

Chronic kidney disease (CKD) is on the rise. One population group that has seen an increase in occurrences of kidney failure is women who are older (50+ years old) and African American.

Type-2 diabetes was the main factor attributed to more African American women experiencing kidney failure. Usually brought on by obesity, diabetes is the number one risk factor for kidney disease. High blood pressure is the second most common risk factor for kidney disease. Making women aware of the risks of CKD and the measures to prevent CKD will hopefully reverse this upward trend. Women are encouraged to talk to their doctor about CKD and find out if they are at risk.

Special issues for women with chronic kidney disease (CKD)

When researching information about kidney disease and dialysis treatments, there is rarely any differentiation between treatments for men and women. There are, however, several unique issues a woman will deal with in her healthcare that should be discussed, such as menstrual periods, sexuality, pregnancy and menopause. The following sections will discuss these issues.

Periods and CKD

When a woman has chronic kidney disease her periods tend to be irregular. Once she begins dialysis her periods may even stop altogether. As kidney function drops below 20 percent of normal, a woman is less likely to conceive because dialysis doesn't perform all of the tasks of the kidneys. The body retains a higher level of waste products than it would with a normal kidney, which can prevent egg production and affect menstruation.

Erythropoietin treatments will cause about 50 percent of woman on dialysis to get their periods again. This is attributed to the improved hormone levels and the treatment of anemia. Therefore, erythropoietin treatments can increase a woman's fertility, so birth control should be used if a woman is sexually active and does not want to become pregnant.

Sexuality and CKD

Most people with CKD find they don't have the same interest in sex. There are emotional, physical and psychological factors at play that can diminish the sex drive. Getting used to life with a chronic illness and the lifestyle changes that come with it takes time. There can also be stresses related to job, income and family life that a woman will have to adjust to.

Physically, lower hormone levels may cause some women to experience vaginal dryness or painful intercourse. A water-soluble vaginal lubricant can be used to remedy these situations. Side effects of certain medicines and complications from uremia can cause fatigue, menstrual irregularities and decreased sexual desire. Some medications may also cause hormonal changes making it difficult for a woman to become aroused or experience an orgasm. A woman should discuss these issues with her doctor, as changes in blood pressure medication or taking extra hormones may help the situation. Anemia can also be treated with erythropoietin, however, sometimes the actual dialysis treatment is the cause of fatigue.

Some women become anxious about changes in their appearance, such as weight loss, or in the case of some PD patients, weight gain from the sugar in the dialysate. The catheter in the abdomen or fistula in the arm may also create anxiety either because a woman believes it is unattractive or is afraid it could be damaged. Sharing these feelings with a partner is often the best way to overcome them. It is also rare that anything will happen to an access in the process of lovemaking.

Most women need a little time to adjust to dialysis. They may find their sex drive returns as their energy level increases. It is best to use contraception when being intimate. Even if a woman isn't having a regular period, she may still be ovulating, making her able to get pregnant. Condoms are a safe and easy choice. There are other options, but a health care professional should be consulted due to hormonal effects of some birth control methods.

Pregnancy and CKD

While it is uncommon for a woman on dialysis to become pregnant, studies indicated that between 1992 and 2003 from 1 to 7 percent of patients did. A national Registry of Pregnancy in Dialysis Patients is maintained to track and study these events and outcomes. About 50 percent of the babies born to women on dialysis survived. There was evidence that longer dialysis time (16-24 hours per week) helped improve infant survival. Many of the babies were born premature, which was attributed to high blood pressure. Many chronic kidney disease patients have high blood pressure, which tends to get worse during pregnancy.

A survey of dialysis units listed by the Health Care Finance Administration regarding pregnancy in dialysis patients showed that infant survival for a woman on dialysis was higher than previously thought. The survey yielded the following results:

During a four-year period two percent of woman in their childbearing years became pregnant (2.4 percent were hemodialysis patients, 1.1 percent were peritoneal dialysis patients).

• Of those who were on dialysis before they became pregnant, 40.2 percent (out of 184 pregnancies) of the infants survived.
• Of those who started dialysis after they became pregnant 73.6 percent (out of 57 pregnancies) of the infants survived.
• Infant survival was greater for women who received dialysis more than 20 hours per week.
• Complications for the women included: high blood pressure in 79 percent of pregnancies, hypertensive crisis in five women, hematocrit lower than 30 for 93.1% of patients, transfusions for 26 percent of those treated with erythropoietin and 77 percent of those not treated and, in two cases, death.
• Complications for the surviving infants included: premature birth in 84 percent of women who conceived after beginning dialysis, congenital anomalies in 11 infants and long-term medical problems for 11 infants.

Menopause and CKD

When kidney failure occurs, dialysis helps to remove wastes from the blood, however, it does not replace all of the functions of the kidneys, such as producing hormones. While all menopausal women are encouraged to take calcium to prevent osteoporosis, it is even more important for those on dialysis or who have a kidney transplant. When hormone production decreases in menopause, this puts women at risk for osteoporosis and cardiovascular disease. Because many women on dialysis tend not to have regular periods, their hormone levels may already be compromised. To help combat osteoporosis, additional calcium in the diet, or in the form of supplements, can help prevent bone loss. Osteoporosis is frequently a complication for those who have a kidney transplant due to the anti-rejection drugs that must be taken.

In addition to osteoporosis, lower hormone levels put women at increased risk for heart disease. A hysterectomy creates early menopause, which puts women at risk for a longer period of time. Women are advised to approach their health care team with questions regarding how to preserve bone and heart health.

Take control of your health when you're a woman with kidney disease

Creating awareness is the best way to help women feel comfortable about bringing up issues to discuss with their healthcare team. Knowing that they are not alone can lead to more openness to help women become more proactive in seeking the special care they need.

Resources

1. Biff F. Palmer. Sexual dysfunction in men and women with chronic kidney disease and end-stage kidney disease. Am J Kidney Dis. 2003 January Vol10 N1
2. D. Shemin, et al. Dialysis in pregnant women with chronic kidney disease. Semin Dial, 2003;16(5):379-383
3. Okundaye I, Abrinko P, Hou S. Registry of pregnancy in dialysis patients.
4. Am J Kidney Dis. 1998 May;31(5):766-73
5. Bagon JA, Vernaeve H, De Muylder X, Lafontaine JJ, Martens J, Van Roost G. Pregnancy and dialysis. Am J Kidney Dis. 1998 May;31(5):756-65.
6. Susan Hou, MD Pregnancy in chronic renal insufficiency and end-stage renal disease. Am J Kidney Dis. 1999 Feb Vol33 N2
7. Holly Mattix Kramer, MD, Gary C. Curhan, MD, ScD, Ajay Singh , MD ,
8. HELP Study Group. Permanent cessation of menses and postmenopausal hormone use in dialysis-dependent women: The HELP study. Am J Kidney Dis. 2003 March Vol41 N3
9. Holly Mattix Kramer, MD, Gary C. Curhan, MD, ScD, Ajay Singh , MD ,
10. HELP Study Group. Hemodialysis and estrogen levels in postmenopausal (HELP) patients: The multicenter HELP study. Am J Kidney Dis. 2003 June Vol41 N6
11. Kramer HM, Curhan G, Singh A; HELP Study Group. Hemodialysis and estrogen levels in postmenopausal (HELP) patients: The multicenter HELP study. Am J Kidney Dis. 2003 Jun;41(6):1240-6.