Introduction:
Women's health in kidney disease continues to remain understudied in recent years and mainly focussed on pregnancy related issues overlooking other significant problems. This study aims to evaluate the bone health, menstrual disturbances and its relationship with hyperprolactinaemia, nutritional and mental health status and its impact on quality of life of women undergoing chronic haemodialysis at a tertiary care centre in South India.
Methods:
This prospective observational study was conducted at a tertiary care hospital in India where 150 patients were undergoing chronic hemodialysis, between July 2023 to June 2024. All women aged 18 years and above who had been undergoing hemodialysis for more than 3 months were included. Basic demographics, clinical profile, lab parameters including corrected calcium, phosphorous, iPTH, serum prolactin level, assessment of nutrition by Malnutrition Inflammation Score (MIS), depression by Beck Depression Inventory, quality of life by SF-36 questionnaire were collected and analyzed. Statistical analysis was performed using SPSS, version 20.0 for windows.
Results:
Out of 150 chronic hemodialysis patients, 40 (26.6%) were women with a mean age of 51.1±11.35years and 38(95%) were younger than 65 years. Diabetes mellitus was present in nearly half of the patients (n=23,57.5%), hypertension in most of them(n=32,80%), CAD and hypothyroidism in 12 patients (30%) each. Irregular menstrual periods occurred in 12 patients (30%) and premature menopause in 3 (7.5%) of the study group. About half of the women had been on dialysis for less than 2 years (n=22,55%). Most of them had AV fistula as the primary vascular access (n=38, 95%). Eight patients (20%) were underweight by BMI while 12(30%) were overweight and obese. Low bone turnover disease was observed in 18 patients (45%) while 32.5% had high bone turn over disease. Hyperprolactinemia (prolactin level > 30ng/ml) was present in 45% of patients, and a significant association was found between Irregular menstrual periods and hyperprolactinemia (p=.001). Depression affected all of them with moderate to severe in 92.5%. Hemoglobin levels were below 10.5 g/dl in all patients. Iron deficiency was present in nearly half of them (57.5%) with 32.5% having severe deficiency (Tsat <20%) Thirty-two (80%) patients had vitamin D level less than 30 ng/ml with low iPTH significantly associated with vitamin D deficiency (p < .02). Malnutrition, as assessed by the MIS score was diagnosed in all patients with mild in 17.5%, moderate in 47.5%, and severe in 35%. Severe malnutrition (p < .01) and severe depression (p < .02) were associated with a significantly lower quality of life.
Conclusions:
In women undergoing chronic hemodialysis, 45% had low bone turnover disease, while 37.5% experienced menstrual disturbances which were strongly correlated with hyperprolactinemia. Vitamin D and iron deficiency were common. Malnutrition and depression were universal among the patients, both related significantly to poor quality of life.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.