Postmenopausal hormone use and the risk of nephrolithiasis

Results from the women's health initiative hormone therapy trials

Naim M. Maalouf, Alicia H. Sato, Brian J. Welch, Barbara V. Howard, Barbara B. Cochrane, Khashayar Sakhaee, John A. Robbins

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Background: Observational studies examining the role of estrogen in the risk of kidney stone formation have shown conflicting results. However, randomized trial evidence on nephrolithiasis risk with estrogen therapy in postmenopausal women is lacking. Methods: We reviewed the incidence of nephrolithiasis in the Women's Health Initiative estrogen-alone and estrogen plus progestin trials conducted at 40 US clinical centers.Atotal of 10 739 postmenopausalwomenwith hysterectomy were randomized to receive 0.625 mg/d of conjugated equine estrogens (CEE) or placebo, and 16 608 postmenopausal women without hysterectomy were randomized to receive placebo or estrogen plus progestin given as CEE plus medroxyprogesterone acetate (2.5 mg/d). The incidence of nephrolithiasis was determined for an average follow-up of 7.1 years for the CEE trial and 5.6 years for the estrogen plus progestin trial. Results: Baseline demographic characteristics and risk factors for nephrolithiasis were similar in the placebo and treatment arms. Estrogen therapy was associated with a significant increase in nephrolithiasis risk from 34 to 39 cases per 10 000 person-years (hazard ratio, 1.21; 95% confidence interval, 1.03-1.44). Censoring data from women when they ceased to adhere to study medication increased the hazard ratio to 1.39 (95% confidence interval, 1.08-1.78). The increased nephrolithiasis risk was independent of progestin coadministration, and effects did not vary significantly according to prerandomization history of nephrolithiasis. Conclusions: These data suggest that estrogen therapy increases the risk of nephrolithiasis in healthy postmenopausal women. These findings should be considered in decision making regarding postmenopausal estrogen use. The mechanisms underlying this higher susceptibility remain to be determined. Trial Registration: clinicaltrials.gov Identifier: NCT0000611.

Original languageEnglish (US)
Pages (from-to)1678-1685
Number of pages8
JournalArchives of Internal Medicine
Volume170
Issue number18
DOIs
StatePublished - Oct 11 2010

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Nephrolithiasis
Women's Health
Estrogens
Hormones
Progestins
Conjugated (USP) Estrogens
Therapeutics
Placebos
Hysterectomy
Confidence Intervals
Medroxyprogesterone Acetate
Kidney Calculi
Incidence
Observational Studies
Decision Making
Demography

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Postmenopausal hormone use and the risk of nephrolithiasis : Results from the women's health initiative hormone therapy trials. / Maalouf, Naim M.; Sato, Alicia H.; Welch, Brian J.; Howard, Barbara V.; Cochrane, Barbara B.; Sakhaee, Khashayar; Robbins, John A.

In: Archives of Internal Medicine, Vol. 170, No. 18, 11.10.2010, p. 1678-1685.

Research output: Contribution to journalArticle

Maalouf, Naim M. ; Sato, Alicia H. ; Welch, Brian J. ; Howard, Barbara V. ; Cochrane, Barbara B. ; Sakhaee, Khashayar ; Robbins, John A. / Postmenopausal hormone use and the risk of nephrolithiasis : Results from the women's health initiative hormone therapy trials. In: Archives of Internal Medicine. 2010 ; Vol. 170, No. 18. pp. 1678-1685.
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abstract = "Background: Observational studies examining the role of estrogen in the risk of kidney stone formation have shown conflicting results. However, randomized trial evidence on nephrolithiasis risk with estrogen therapy in postmenopausal women is lacking. Methods: We reviewed the incidence of nephrolithiasis in the Women's Health Initiative estrogen-alone and estrogen plus progestin trials conducted at 40 US clinical centers.Atotal of 10 739 postmenopausalwomenwith hysterectomy were randomized to receive 0.625 mg/d of conjugated equine estrogens (CEE) or placebo, and 16 608 postmenopausal women without hysterectomy were randomized to receive placebo or estrogen plus progestin given as CEE plus medroxyprogesterone acetate (2.5 mg/d). The incidence of nephrolithiasis was determined for an average follow-up of 7.1 years for the CEE trial and 5.6 years for the estrogen plus progestin trial. Results: Baseline demographic characteristics and risk factors for nephrolithiasis were similar in the placebo and treatment arms. Estrogen therapy was associated with a significant increase in nephrolithiasis risk from 34 to 39 cases per 10 000 person-years (hazard ratio, 1.21; 95{\%} confidence interval, 1.03-1.44). Censoring data from women when they ceased to adhere to study medication increased the hazard ratio to 1.39 (95{\%} confidence interval, 1.08-1.78). The increased nephrolithiasis risk was independent of progestin coadministration, and effects did not vary significantly according to prerandomization history of nephrolithiasis. Conclusions: These data suggest that estrogen therapy increases the risk of nephrolithiasis in healthy postmenopausal women. These findings should be considered in decision making regarding postmenopausal estrogen use. The mechanisms underlying this higher susceptibility remain to be determined. Trial Registration: clinicaltrials.gov Identifier: NCT0000611.",
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