CKD: women show lower risk for ESRD, death in CRIC

  • Ricardo AC & al.
  • J Am Soc Nephrol
  • 3 Dec 2018

  • curated by Yael Waknine
  • Clinical Essentials
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Takeaway

  • Among patients with chronic kidney disease (CKD), female sex is tied to a lower risk for end-stage renal disease (ESRD) and death.

Why this matters

  • US CKD prevalence is higher among women than men, but men are 1.5-fold more likely to develop ESRD.
  • Prior studies were limited by small minority recruitment and yielded mixed results regarding sex-related disparities in progression.

Study design

  • 3939 adults (mean age, 58 years; 45.1% women) from the ongoing, prospective Chronic Renal Insufficiency Cohort (CRIC) study; 42% were black and 13% were Hispanic.
  • Mean estimated glomerular filtration rate (eGFR, in mL/minute/1.73 m2) was 44 in women, 46 in men.
  • Funding: NIDDK, NIH, Kaiser Permanente, others.  

Key results

  • Over a median follow-up of 6.9 years, 21.4% developed ESRD (490 men, 354 women) and 21.7% died (524 men, 329 women).
  • In multivariate analysis, women had lower risk vs men for:
    • ESRD (HR=0.72; 95% CI, 0.59-0.87).
    • 50% eGFR decline (HR=0.82; 95% CI, 0.69-0.96).
    • Progression to stage V CKD (HR=0.84; 95% CI, 0.74-0.94).
    • Death (HR=0.56; 95% CI, 0.44-0.70), even with ESRD as a censoring event (HR=0.64; 95% CI, 0.55-0.74).
  • Mean unadjusted rate of eGFR decline was lower in women than men (–1.09 vs –1.43 mL/minute/1.73 m2), but lost significance in multivariate adjustment (P=.31).

Limitations

  • Potential enrollment bias.

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