MENOPAUSAL HORMONE THERAPY AND RISK OF DEMENTIA IN WOMENWITH PRE-DIALYSIS CKD: A NATIONWIDE OBSERVATIONAL COHORT STUDY

초록

Background and Aims:The risk of dementia is increased in postmenopausal women. The incidences of premature menopause and dementia are increased in patients with chronic kidney disease (CKD). Therefore, the potential benefit of hormone replacement therapy (HRT) for cognitive function may be a more critical issue in CKD patients.Method:Menopausal women over 40 years with or without HRT were identified through the National Health Screening questionnaire in 2009. Among the subjects, those newly diagnosed with CKD between 2009 and 2013 were enrolled. HRT was used as an exposure variable and was followed from the day when CKD was diagnosed to December 2019. The hazard ratio (HR) of dementia was evaluated using a 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 occurred in 107,848 (14.3%), Alzheimer's disease in 87,833 (11.6%), and vascular dementia in 10,245 (1.4%). HRT was significantly associated with a lower risk of dementia in the adjusted Cox regression model (all-cause dementia: hazard ratio [HR] 0.796, 95% confidence interval [95% CI] 0.776-0.816, P < 0.001; Alzheimer's disease: HR 0.795, 95% CI 0.773-0.818, P < 0.001; vascular dementia: HR 0.803, 95% CI 0.743-0.868, P < 0.001).Conclusion:HRT was significantly associated with a lower risk of CKD-related cognitive dysfunction in postmenopausal women. Prospective studies on whether HRT lowers the risk of dementia in menopausal women with CKD are needed.