Menstrual Abnormalities and Reproductive Lifespan in Females with CKD: A Systematic Review and Meta-Analysis

Clin J Am Soc Nephrol. 2022 Dec;17(12):1742-1753. doi: 10.2215/CJN.07100622. Epub 2022 Nov 23.


Background and objectives: Menstrual abnormalities and shortened reproductive lifespan are associated with shorter life expectancy and higher cardiovascular and osteoporosis risk in the general population, although the magnitude of these reproductive factor irregularities in females with CKD is unclear. This systematic review and meta-analysis aimed to summarize the current knowledge regarding menstrual abnormalities and reproductive lifespan among females with CKD.

Design, setting, participants, & measurements: A comprehensive bibliographic search (MEDLINE, Embase, and Cumulative Index to Nursing and Allied Health Literature [CINAHL]) was completed from database inception to February 2022 to identify all original articles reporting on females of reproductive age with nondialysis-dependent/nonkidney transplant CKD, dialysis-dependent CKD, or kidney transplantation and menstruation patterns, age of menarche, and/or menopause. Data extraction and study quality assessment were completed in duplicate. Random effects meta-analyses were used to derive pooled proportions estimates.

Results: Forty-six studies were identified, and 35 were meta-analyzed, stratified by KRT modality and reported outcome. Menstrual abnormalities were present in 19%-47% of patients on hemodialysis and 75% of patients on peritoneal dialysis. Kidney transplantation was associated with a 7%-30% decrease in menstrual abnormalities. Reproductive lifespan was 32 years (95% confidence interval, 30 to 34 years). Although significant heterogeneity was present, study quality ranged from fair to good, and no evidence of publication bias was noted.

Conclusions: Menstrual abnormalities and shorter reproductive lifespan are common in females with CKD, although kidney transplantation may improve menstrual health.

Keywords: chronic kidney disease; dialysis; end stage kidney disease; kidney transplantation; menarche; menopause; menstrual disturbances; menstrual irregularities; menstruation; reproductive life span.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Female
  • Humans
  • Kidney Transplantation*
  • Longevity
  • Renal Dialysis
  • Renal Insufficiency, Chronic* / therapy