ArticleBMC public health2026
Lifetime cumulative effect of reproductive factors, "Life's essential 8" health status and risk of chronic kidney disease: a nationwide prospective cohort study.
Article in BMC public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundLittle has been found regarding the lifetime cumulative effect of reproductive factors on chronic kidney disease (CKD), and how this relationship varies with cardiovascular health (CVH) remains unexplored. This study aimed to assess the relationships of lifetime cumulative estrogen exposure reflected by reproductive factors, and LE8 CVH status with incident CKD among postmenopausal women.
methodsThe study included 33,700 postmenopausal participants from the China Cardiometabolic Disease and Cancer Cohort (4 C) Study, enrolled between 2011 and 2012 with follow-up assessments conducted between 2014 and 2016 (median follow-up: 3.1 years). Lifetime cumulative estrogen exposure due to reproductive factors was evaluated through reproductive lifespan (RLS), endogenous estrogen exposure (EEE), and total estrogen exposure (TEE). Health behaviors information in Life's Essential 8 (LE8) was collected by questionnaire and laboratory examination. The risk of CKD was analyzed with Cox proportional hazards models.
resultsShorter lifetime cumulative estrogen exposure was associated with an increased risk of CKD (RLS, HR: 1.42, 95% CI: 1.19-1.70; EEE, HR: 1.39, 95% CI: 1.12-1.72; TEE, HR: 1.28, 95% CI: 1.06-1.54). Moreover, the risk decreased gradually with increasing number of optimal cardiovascular health metrics (OCVHMs). Participants with shorter duration of lifetime cumulative estrogen exposure combined with 5 or more OCVHMs no longer conferred risk for incident CKD (RLS, HR: 1.01, 95% CI: 0.70-1.47; EEE, HR: 1.15, 95% CI: 0.80-1.65; TEE, HR: 0.95, 95% CI: 0.65-1.37).
conclusionsShorter lifetime cumulative estrogen exposure was correlated with an elevated risk of CKD. It should be encouraged for postmenopausal women to preserve good CVH status for prevention of CKD.
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