Menopausal Status and Thrombosis Risk in Hemodialysis Catheter Use: A Secondary Analysis of a Prospective Cohort.

Background: Current literature lacks research on the link between menopause and central venous catheter (CVC) thrombosis risk. The aim of the study is to evaluate the association between menopausal status and catheter thrombosis. Methods: This study analyzed a subset of 322 female patients with tunneled CVC placement from a previously published cohort that was conducted at Hasheminejad Kidney Center, Tehran, Iran (2015-2019). Menopausal status was determined based on clinical documentation and menstrual history (cessation of menses for ≥12 months, history of bilateral oophorectomy, or documented clinical diagnosis. Catheter outcomes were classified as dysfunction due to thrombosis or infection. Results: Postmenopausal women were significantly older than premenopausal women (62.9 vs 38.6 years, p<0.001), and analyses were adjusted for age to account for this confounding. Catheter thrombosis occurred more frequently among postmenopausal women (68.3% vs 37.9%, p < 0.001), while infection was more common in premenopausal patients (38.9% vs 18.5%, p < 0.001). In the adjusted competing risk model for thrombosis, postmenopausal status was associated with a significantly higher subdistribution hazard (SHR = 2.54; 95% CI: 1.30-4.94; p = 0.006), along with higher BMI (SHR = 1.04 per unit; p = 0.017) and hypertension (SHR = 1.62; p = 0.029). In contrast, menopausal status was not significantly associated with infection risk (SHR = 0.52; p = 0.146), although diabetes showed a borderline association (SHR = 1.81; p = 0.071). Conclusion: Postmenopausal status was associated with increased risk of catheter thrombosis in this hypothesis-generating analysis. These findings highlight the need for prospective studies investigating hormonal influences on catheter-related complications.