Menopausal hormone therapy and risk for dementia in women with CKD: A nationwide observational cohort study

Abstract

Aim: The risk for dementia is increased in postmenopausal women. The incidences of premature menopause and dementia have increased in patients with chronic kidney disease (CKD). The potential benefits of hormone replacement therapy (HRT) on cognitive function may be a more critical issue for patients with CKD. Methods: Women aged >40 years with or without HRT were identified using the 2009 National Health Screening Questionnaire. Women who were newly diagnosed with CKD between 2009 and 2013 were enrolled. HRT was used as an exposure variable, and participants were followed from the day CKD was diagnosed to December 2019. The hazard ratio (HR) for dementia was evaluated using Cox proportional hazards regression analysis. Results: We included 755 426 postmenopausal women with CKD. The median follow-up period was 7.3 (IQR, 5.8–8.7) years. All-cause dementia, Alzheimer's disease, and vascular dementia occurred in 107 848 (14.3%), 87 833 (11.6%), and 10 245 (1.4%) women, respectively. HRT was significantly associated with a lower risk for dementia in the adjusted Cox regression model (all-cause dementia: HR 0.80; 95% confidence interval [CI] 0.78–0.82; p < 0.001; Alzheimer's disease: HR 0.80; 95% CI 0.77–0.82; p < 0.001; vascular dementia: HR 0.80; 95% CI 0.74–0.87; p < 0.001). Conclusions: HRT was significantly associated with a lower risk for CKD-related cognitive dysfunction in postmenopausal women. Prospective studies are needed to determine whether HRT lowers the risk for dementia in menopausal women with CKD. © 2023 Asian Pacific Society of Nephrology.