Rationale & Objective:Data for the associationof sex with chronic kidney disease (CKD) pro-gression are conflicting, a relationship this studysought to examine.Study Design:Pooled analysis of 4 Italianobservational cohort studies.Setting & Participants:1,311 older men and1,024 older women with estimated glomerularfiltration rate (eGFR)<45 mL/min/1.73 m2fol-lowed up in renal clinics.Predictor:Sex.Outcomes:End-stage kidney disease (ESKD),defined as maintenance dialysis or kidney trans-plantation, as the primary outcome; all-causemortality and eGFR decline as secondary outcomes.Analytical Approach:Cox proportional hazardanalysis to estimate the relative risk for ESKD andmortality and linear mixed models to estimate therate of eGFR decline.Results:Age, systolic blood pressure, and use ofrenin-angiotensin system inhibitors were similar inmen and women. Baseline eGFRs were27.6±10.2 in men and 26.0±10.6 mL/min/1.73 m2in women (P<0.001), while medianproteinuria was lower in women (proteinexcretion, 0.45 [IQR, 0.14-1.10] g/d) comparedwith men (0.69 [IQR 0.19-1.60] g/d;P<0.001). During a median follow-up of 4.2years, 757 developed ESKD (59.4%men) and471 died (58.4%men). The adjusted risks forESKD and mortality were higher in men (HRs of1.50 [95%CI, 1.28-1.77] and 1.30 [95%CI,1.06-1.60], respectively). Thisfinding wasconsistent across CKD stages. We observed asignificant interaction between sex andproteinuria, with the risk for ESKD in men beingsignificantly greater than for women at a level ofproteinuria ofw0.5 g/d or greater. The slope ofdecline in eGFR was steeper in men (−2.09;95%CI,−2.21 to−1.97 mL/min/1.73 m2peryear) than in women (−1.79; 95%CI,−1.92to−1.66 mL/min/1.73 m2per year;P<0.001).Although sex differences in eGFR decline werenot different across CKD stages (P=0.3), thedifference in slopes between men and womenwas progressively larger with proteinuria>0.5 g/d (P=0.04).Limitations:Residual confounding; only whiteswere included.Conclusions:Excess renal risk in men may, atleast in part, be related to higher levels of pro-teinuria in men compared with women.
Sex Differences in the Progression of CKD Among OlderPatients: Pooled Analysis of 4 Cohort Studies / Minutolo, Roberto; Gabbai, Francis B.; Chiodini, Paolo; Provenzano, Michele; Borrelli, Silvio; Garofalo, Carlo; Bellizzi, Vincenzo; Russo, Domenico; Conte, Giuseppe; Nicola., Luca De. - In: AMERICAN JOURNAL OF KIDNEY DISEASES. - ISSN 0272-6386. - 75:(2020), pp. 30-38.
Sex Differences in the Progression of CKD Among OlderPatients: Pooled Analysis of 4 Cohort Studies
Domenico RussoSupervision
;
2020
Abstract
Rationale & Objective:Data for the associationof sex with chronic kidney disease (CKD) pro-gression are conflicting, a relationship this studysought to examine.Study Design:Pooled analysis of 4 Italianobservational cohort studies.Setting & Participants:1,311 older men and1,024 older women with estimated glomerularfiltration rate (eGFR)<45 mL/min/1.73 m2fol-lowed up in renal clinics.Predictor:Sex.Outcomes:End-stage kidney disease (ESKD),defined as maintenance dialysis or kidney trans-plantation, as the primary outcome; all-causemortality and eGFR decline as secondary outcomes.Analytical Approach:Cox proportional hazardanalysis to estimate the relative risk for ESKD andmortality and linear mixed models to estimate therate of eGFR decline.Results:Age, systolic blood pressure, and use ofrenin-angiotensin system inhibitors were similar inmen and women. Baseline eGFRs were27.6±10.2 in men and 26.0±10.6 mL/min/1.73 m2in women (P<0.001), while medianproteinuria was lower in women (proteinexcretion, 0.45 [IQR, 0.14-1.10] g/d) comparedwith men (0.69 [IQR 0.19-1.60] g/d;P<0.001). During a median follow-up of 4.2years, 757 developed ESKD (59.4%men) and471 died (58.4%men). The adjusted risks forESKD and mortality were higher in men (HRs of1.50 [95%CI, 1.28-1.77] and 1.30 [95%CI,1.06-1.60], respectively). Thisfinding wasconsistent across CKD stages. We observed asignificant interaction between sex andproteinuria, with the risk for ESKD in men beingsignificantly greater than for women at a level ofproteinuria ofw0.5 g/d or greater. The slope ofdecline in eGFR was steeper in men (−2.09;95%CI,−2.21 to−1.97 mL/min/1.73 m2peryear) than in women (−1.79; 95%CI,−1.92to−1.66 mL/min/1.73 m2per year;P<0.001).Although sex differences in eGFR decline werenot different across CKD stages (P=0.3), thedifference in slopes between men and womenwas progressively larger with proteinuria>0.5 g/d (P=0.04).Limitations:Residual confounding; only whiteswere included.Conclusions:Excess renal risk in men may, atleast in part, be related to higher levels of pro-teinuria in men compared with women.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
