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Abstract: TH-PO395

Sex Differences in the Risk of ESKD and Death Among Patients with Moderate to Advanced CKD Followed Up in Renal Clinics

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Minutolo, Roberto, University of Campania, Naples, Italy
  • Gabbai, Francis B., VA San Diego Healthcare System and University of California at San Diego, San Diego, California, United States
  • De Nicola, Luca, University of Campania, Napoli, Italy
Background

Data on sex-specific differences in the epidemiology of CKD may help nephrologists to better tailor treatments for their patients. However, studies evaluating the association of sex with CKD progression have provided conflicting results.

Methods

We pooled four observational cohort studies including consecutive CKD patients (not dialysis/transplant) under stable Nephrology care for >6 months. Out of 3,212 unique patients, we selected 1,311 men and 1,024 women with eGFR<45 mL/min/1.73m2. Primary outcome was ESKD (chronic dialysis or renal transplantation); all-cause mortality and eGFR decline were secondary outcomes. We used multivariable Cox proportional hazard analysis to estimate relative risk of ESKD and all-cause mortality, and linear mixed models to estimate the rate of eGFR decline.

Results

Age (67±14 y), systolic BP (139±20 mmHg), use of RAS inhibitors (69%), antihypertensive drugs (2.3±1.2) and statins (30%) were similar in men and women. Compared to men, women had lower eGFR (26±11 vs 28±10 mL/min/1.73m2, P<0.001) and lower proteinuria (0.45 g/d IQR 0.14-1.10 vs 0.69 g/d, IQR 0.19-1.60, P<0.001). During a median follow-up of 4.2 years, 757 developed ESKD (307 women) and 471 died (196 women). Table reports the adjusted risk (HR and 95%CI) of ESKD and all-cause mortality overall and by CKD stages. We found a significant interaction between sex and proteinuria with the risk of ESKD in men becoming significantly greater at a level of proteinuria ≥0.5 g/d. Rate of eGFR decline (mL/min/year) was greater in men than in women (2.1 95%CI 2.0 -2.2 vs 1.8, 95%CI 1.7-1.9, P<0.001) with no difference across CKD stages (P=0.28). The difference in slopes between men and women was progressively larger with proteinuria levels ≥0.5 g/d (P=0.04).

Conclusion

Our study highlights an excess of renal risk in men possibly related, at least in part, to the higher levels of proteinuria in men compared to women.

 OverallCKD stage 3B
(eGFR 30-45)
CKD stage 4
(eGFR 15-29)
CKD stage 5
(eGFR<15)
ESKD: WomenReferenceReferenceReferenceReference
Men1.50
(1.27-1.77)
1.52
(1.03-2.24)
1.58
(1.25-1.99)
1.41
(1.09-1.83)
Mortality: WomenReferenceReferenceReferenceReference
Men1.32
(1.07-1.62)
1.49
(1.09-2.02)
1.19
(0.89-1.60)
1.27
(0.72-2.26)

Adjusted for age, smoking, BMI, cause of CKD, history of CVD, LVH, systolic BP, cholesterol, phosphate, albumin, hemoglobin, GFR, proteinuria, use of RAS inhibitors and stratified by cohort