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J Am Soc Nephrol. 2019 Jan;30(1):137-146. doi: 10.1681/ASN.2018030296. Epub 2018 Dec 3.

Sex-Related Disparities in CKD Progression.

Author information

1
Department of Medicine, Institute for Minority Health Research, University of Illinois at Chicago, Chicago, Illinois; aricar2@uic.edu.
2
Departments of Medicine and Epidemiology and Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania.
3
Department of Medicine, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland.
4
Departments of Medicine and.
5
Epidemiology, Tulane University, New Orleans, Louisiana.
6
Department of Medicine, Institute for Minority Health Research, University of Illinois at Chicago, Chicago, Illinois.
7
Department of Medicine, University of Michigan, Ann Arbor, Michigan.
8
Department of Medicine, Case Western University, University Hospitals Case Medical Center, Cleveland, Ohio.
9
Department of Medicine, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts.
10
Department of Medicine, University of Chicago, Chicago, Illinois; and.
11
Department of Medicine, University of California, San Diego, California.

Abstract

BACKGROUND:

In the United States, incidence of ESRD is 1.5 times higher in men than in women, despite men's lower prevalence of CKD. Prior studies, limited by inclusion of small percentages of minorities and other factors, suggested that men have more rapid CKD progression, but this finding has been inconsistent.

METHODS:

In our prospective investigation of sex differences in CKD progression, we used data from 3939 adults (1778 women and 2161 men) enrolled in the Chronic Renal Insufficiency Cohort Study, a large, diverse CKD cohort. We evaluated associations between sex (women versus men) and outcomes, specifically incident ESRD (defined as undergoing dialysis or a kidney transplant), 50% eGFR decline from baseline, incident CKD stage 5 (eGFR<15 ml/min per 1.73 m2), eGFR slope, and all-cause death.

RESULTS:

Participants' mean age was 58 years at study entry; 42% were non-Hispanic black, and 13% were Hispanic. During median follow-up of 6.9 years, 844 individuals developed ESRD, and 853 died. In multivariable regression models, compared with men, women had significantly lower risk of ESRD, 50% eGFR decline, progression to CKD stage 5, and death. The mean unadjusted eGFR slope was -1.09 ml/min per 1.73 m2 per year in women and -1.43 ml/min per 1.73 m2 per year in men, but this difference was not significant after multivariable adjustment.

CONCLUSIONS:

In this CKD cohort, women had lower risk of CKD progression and death compared with men. Additional investigation is needed to identify biologic and psychosocial factors underlying these sex-related differences.

KEYWORDS:

ESRD; Epidemiology and outcomes; chronic kidney disease; mortality risk

PMID:
30510134
PMCID:
PMC6317604
[Available on 2020-01-01]
DOI:
10.1681/ASN.2018030296

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