CKD: risk for kidney failure is 50% higher in elderly men vs women

  • Minutolo R & al.
  • Am J Kidney Dis
  • 10 Aug 2019

  • International Clinical Digest
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Takeaway

  • Older men with chronic kidney disease (CKD) have a 50% higher risk for progression to end-stage renal disease (ESRD) than their female peers, in part because of higher levels of proteinuria.

Why this matters

  • “In the era of precision medicine, gaining sex-specific data is a necessary step to correctly implement individualised treatment,” the authors note.

Study design

  • Pooled data from 4 observational cohort studies involving 2335 people (56.1% male; mean age, 67.1 years) with estimated glomerular filtration rate (eGFR, in mL/minute/1.73 m2)
  • Men had higher mean baseline eGFR (27.6±10.2 vs 26.0±10.6; P<.001 and median protein excretion vs g>
  • Funding: None.   

Key results

  • Over a median 4.2 years, 471 participants died (58.4% male) and 727 developed ESRD (59.4% male).
  • In adjusted analysis, ESRD risk was 50% higher in men vs women (adjusted [a]HR, 1.50; 95% CI, 1.27-1.77).
    • Mortality risk was 32% higher (aHR, 1.32; 95% CI, 1.07-1.62).
  • ESRD risk became significantly greater in men vs women with proteinuria ≥0.5 g/day.
  • Slope of annualized eGFR decline was steeper in men vs women (−2.09 [95% CI, −2.21 to −1.97] vs −1.79 [95% CI, −1.92 to −1.66]; P<.001>
  • Gap between slopes progressively increased with proteinuria >0.5 g/day (P=.04) but not CKD stage (P=.3).

Limitations

  • White-only population.