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Kidney Week

Abstract: TH-PO719

The Incidence of CKD and ESRD Is Higher in Hypertensive Men Than Women: A Systematic Review and Meta-Analysis

Session Information

Category: Women’s Health and Kidney Diseases

  • 2000 Women’s Health and Kidney Diseases


  • Weldegiorgis, Misghina, The George Institute for Global Health, University of Oxford, Oxford, United Kingdom

Hypertension, defined as systolic blood pressure (SBP) ≥140 mmHg, is an established risk factor for chronic kidney disease (CKD) and end-stage renal disease (ESRD). Whether sex differences in CKD and ESRD incidence exist among hypertensive individuals remains unclear. This systematic review and meta-analysis was conducted to evaluate the relative effect of hypertension on CKD and ESRD risk in women compared with men.


Cohort studies were systematically searched in Embase and PubMed until April 2017. Studies were selected if they reported a sex-specific relationship between SBP and CKD and/or ESRD. Random effects meta-analyses with inverse variance weighting were used to obtain sex-specific relative risks (RRs) and the RR ratio (RRR) (women to men) for incident CKD and ESRD.


Data from six cohorts, including 2,382,712 individuals and 6,856 incident CKD events and 833 ESRD events, were identified. The RR for incident CKD or ESRD associated with hypertension versus ideal blood pressure (SBP <120 mmHg) was 1.58 (95% CI, 1.30-1.92) in women and 2.03 (95% CI, 1.65-2.49) in men. The RR for incident CKD or ESRD was 18% lower in women than in men (RRR 0.82 [95% CI, 0.71-0.94]) with no significant heterogeneity between studies (I2=0%) (Figure 1).


Hypertension confers an 18% lower excess risk of incident CKD or ESRD in women compared with men. Sex differences in onset, duration, and severity of some risk factors, such as albuminuria, diabetes, cardiovascular disease, obesity, and socioeconomic status may explain part of the excess risk in men. Another explanation could be that women might be less likely to initiate dialysis or may be at increased risk of mortality than men. Future studies are warranted to more clearly elucidate the mechanisms responsible for the observed substantial sex differences.

Figure 1. Women-to-men relative risk ratio for CKD and ESRD, comparing individuals in hypertension versus ideal BP