Diabetes mellitus as a risk factor for incident chronic kidney disease and end-stage renal disease in women compared with men: a systematic review and meta-analysis

Abstract

Diabetes mellitus is a strong risk factor for chronic kidney disease and end-stage renal disease. Whether sex differences in chronic kidney disease and end-stage renal disease incidence exist among diabetic patients remains unclear. This systematic review and meta-analysis was conducted to evaluate the relative effect of diabetes on chronic kidney disease and end-stage renal disease risk in women compared with men. We systematically searched Embase, PubMed, and the Cochrane Library for both cohort and case-control studies until October 2015. Studies were selected if they reported a sex-specific relationship between diabetes mellitus and chronic kidney disease or end-stage renal disease. We generated pooled estimates across studies using random-effects meta-analysis after log transformation with inverse variance weighting. Ten studies with data from more than 5 million participants were included. The pooled adjusted risk ratio of chronic kidney disease associated with diabetes mellitus was 3.34 (95 % CI 2.27, 4.93) in women and 2.84 (95 % CI 1.73, 4.68) in men. The data showed no difference in diabetes-related chronic kidney disease risk between the sexes (pooled adjusted women-to-men relative risk ratio was 1.14 [95 % CI 0.97, 1.34]) except for end-stage renal disease-the pooled adjusted women-to men relative risk ratio was 1.38 (95 % CI 1.22, 1.55; p = 0.114, I² = 38.1 %). The study found no evidence of a sex difference in the association between diabetes mellitus and chronic kidney disease. However, the excess risk for end-stage renal disease was higher in women with diabetes than in men with the same condition, from which we assume that the female gender could accelerate the disease progression. Further studies are needed to support this notion and elucidate the underlying mechanisms.

Metabolic syndrome and its components are associated with increased chronic kidney disease risk: Evidence from a meta-analysis on 11 109 003 participants from 66 studies

“…While diabetic subgroup with lower values of HDL‐cholesterol or increased BMI/waist circumference had significantly elevated risk, no such relationships were detected for the non‐diabetic subgroup. Moreover, the risk conveyed by different components of MetS varied and was highest for increased blood pressure and impaired fasting glucose, confirming the results of previous meta‐analyses which identified diabetes and hypertension as the main risk factors for the development and progression of CKD.…”

“…While diabetic subgroup with lower values of HDL-cholesterol or increased BMI/waist circumference had significantly elevated risk, no such relationships were detected for the non-diabetic subgroup. Moreover, the risk conveyed by different components of MetS varied and was highest for increased blood pressure and impaired fasting glucose, confirming the results of previous meta-analyses84,85 which identified diabetes and hypertension as the main risk factors for the development and progression of CKD. This study supports the overall results of Thomas et al 86 metaanalysis, in which the presence of MetS was related to the incidence of eGFR ˂60 mL/min per 1.73 m 2 and the risk estimateaugmented as the number of MetS traits increased.…”

Associations of Waist Circumference, Socioeconomic, Environmental, and Behavioral Factors with Chronic Kidney Disease in Normal Weight, Overweight, and Obese People

“…In addition, married people had lower prevalence of diabetes and smoking [38]. Diabetes [39,40], and smoking [26] were recognized as important predictors of CKD. Taken together, married or cohabited people had lower blood pressure, higher hypertension awareness and control, and lower prevalence of diabetes and smoking, which, in turn, led to a lower risk of CKD as compared with unmarried people.…”

“…It has been proven that hypertension is a cause and complication of CKD [24,[41][42][43]. In addition, diabetes was one of the most common causes of CKD [39,40,43]. On the other hand, insulin resistance was independently associated with cardiovascular risks in ESRD patients [44].…”

Disease spectrum and outcomes among elderly patients in two tertiary hospitals in Dar es Salaam, Tanzania

“…These findings were expected given that aging is associated with increasing arterial stiffness and vascular resistance which leads to increasing blood pressure, strokes and myocardial ischemia, declining glomerular filtration rate and impaired response to antidiuretic hormone [17–19]. In addition, the presence of one of these diseases may be is a risk factor for another, for example, the presence of hypertension is a risk factor for heart failure or the presence of diabetes mellitus and hypertension form a significant risk for chronic kidney disease and stroke [20,21]. Indeed similar pattern of diseases among elderly medical admissions has been reported from other centers[3–5].…”