Women's health issues in a dialysis population

Background: As women receiving hemodialysis are evaluated frequently by the nephrologist, we hypothesized that women's health issues are better addressed in the dialysis patient than in the general population. Patients and methods: We surveyed the female patients in our dialysis population. 97% of the women approached agreed to participate. We found that 55.4% of our cohort had received routine gynecologic care. 50% of the women had undergone a Papanicolaou (Pap) smear in the last year. Of the women aged 40-50, 55% had undergone a mammogram in the last 2 years. In women over age 50, 71% received an annual mammogram. Results: We found that 57% of the women were amenorrheic before starting renal replacement therapy while 16% had become amenorrheic after dialysis was started. 27% were still menstruating at the time of the survey. Only 4% of the amenorrheic women interviewed were currently on hormone replacement therapy (HRT) as compared with 20% of women in our general medical clinics. While 67% stated that they would take hormone replacement if offered, 89% had never been offered HRT. Variables that positively correlated with willingness to take HRT were a history of a hysterectomy and more skilled work history. Although nephrologists surveyed at our academic facility agreed that amenorrheic women with renal disease benefited from HRT, many believed that it is not the role of the nephrologist to prescribe it. Conclusion: Despite frequent contacts with medical providers, women's health issues for patients on dialysis may not receive the same attention as women in the general population there is significant information and on-going research on the hormonal health of normal women, there is limited information on the impact of uremia on these health issues. Because the dialysis patient has frequent encounters with medical providers, we hypothesized that women's health issues are being adequately addressed as compared with the population in our general medical clinics. We sought to define these issues in a population of women on dialysis. By using a questionnaire and interview we obtained information on menses and characterized the patterns of amenorrhea in women with renal disease. We assessed cardiovascular risk factors that would be benefited from HRT. We noted the use of HRT by women on dialysis, the willingness of these women to take HRT if recommended by a physician, and the reasons why the woman would decline therapy if offered. We examined the factors that correlated with patients' acceptance of HRT. Finally, we surveyed faculty nephrologists at our institution to define their position regarding the use of HRT for their female patients on dialysis.