Kidney Week

Abstract: SA-PO0781

Sex Differences in Kidney Failure in Adults Enrolled in CureGN

Session Information

• Glomerular Research: Design, Registries, Surveys, and Epidemiology
  November 08, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

• Reynolds, Monica Lona, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States

Monica Lona Reynolds, MD, MS, FASN

• Banker, Margaret, Northwestern University, Evanston, Illinois, United States

Margaret Banker, PhD

• Derebail, Vimal K., The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States

Vimal K. Derebail, MD, MPH, FASN

• Smith, Abigail R., Northwestern University, Evanston, Illinois, United States

Abigail R. Smith, PhD

• Mariani, Laura H., University of Michigan Medical School, Ann Arbor, Michigan, United States

Laura H. Mariani, MD, MS, FASN

• Hladunewich, Michelle A., University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada

Michelle A. Hladunewich, MD, MS, FASN

• Oliverio, Andrea L., University of Michigan Medical School, Ann Arbor, Michigan, United States

Andrea L. Oliverio, MD, MSc

Background

Prior studies of sex differences in CKD are from earlier treatment eras or among older, post-menopausal cohorts. We sought to assess sex differences in a longitudinal contemporary cohort of primary glomerular disease (GN) to understand sex-related risk factors and treatment patterns in females vs males.

Methods

All adults enrolled in CureGN were included. The primary outcome was kidney failure (KF), defined as reaching dialysis, transplant, or an eGFR < 15ml/min/1.73m² on two occasions. Kaplan-Meier curves and Cox proportional hazard models adjusted for diagnosis, race and ethnicity, age, eGFR, UPCR, and hypertension at enrollment, assessed risk for KF in females vs males. Longitudinal logistic regression assessed odds of renin-angiotensin aldosterone system inhibitor (RAASi) prescription at each study visit by sex and age. Subgroups by age were categorized based on the mean age of menopause in women (18-50 yrs vs > 50 yrs).

Results

Table 1 describes the cohort at enrollment. In adjusted models, females had lower risk of KF than males (aHR 0.76, 95% CI 0.58-0.98). In disease-stratified models, females with MN had lower risk of KF but there was no sex difference in IgA nephropathy or FSGS (Figure 1). Over follow-up, females 18-50 yrs had lower odds of receiving RAASi than all other subgroups (vs males 18-50 yrs: OR 0.25, p<0.001) excluding those with pregnancy after enrollment. Females >50 yrs had similar odds to both male subgroups.

Conclusion

Females were at lower risk of KF after a median follow-up of 5.6 years, after adjustment for enrollment characteristics. Given that younger females were also less likely to receive supportive RAASi therapy, other factors likely play a protective role.

Characteristics at enrollment

Funding

• NIDDK Support

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025zhxjys21