Gender, Albuminuria and Chronic Kidney Disease Progression in Treated Diabetic Kidney Disease

Abstract

Background: Women are reported to have a lower incidence of renal replacement therapy, despite a higher prevalence of chronic kidney disease (CKD). Aim: To analyze diabetic kidney disease (DKD) progression in men and women. Methods: Prospective cohort: n = 261, 35% women, new consecutive nephrology DKD referrals. Results: Women smoked less and better complied with the dietary phosphate and sodium restrictions. Despite a less frequent nephrology referral, women had lower baseline albuminuria. Over a 30 ± 10-month follow-up, albuminuria decreased in women and the estimated glomerular filtration rate (eGFR) loss was slower than in men. However, the percentage of rapid progressors was similar in both sexes. The best multivariate model predicting rapid progression in men (area under curve (AUC) = 0.92) and women differed. Albuminuria and fractional excretion of phosphate (FEphosphate) were part of the men multivariable model, but not of women. The AUC for the prediction of rapid progression by albuminuria was higher in men than in women, and the albuminuria cut-off points also differed. In women, there was a higher percentage of rapid progressors who had baseline physiological albuminuria. Conclusions: Female DKD differs from male DKD: albuminuria was milder and better responsive to therapy, the loss of eGFR was slower and the predictors of rapid progression differed from men: albuminuria was a better predictor in men than in women. Lifestyle factors may contribute to the differences.

The GenoDiabMar Registry: A Collaborative Research Platform of Type 2 Diabetes Patients

“…The characteristics of the evolution of renal function and the differences found between the sexes in morbimortality are similar to those described in the literature [ 42 , 43 , 44 ] for DKD patients. This observation reinforces the value of this registry as a population, with renal characteristics comparable to other cohorts, so as to be able to carry out collaborative studies.…”

The GenoDiabMar registry. A collaborative research platform of “real world” type 2 diabetes patients

“…These findings can help to identify early clinical and analytical risk factors for worse renal evolution in a differential and more personalized way. The characteristics of the evolution of renal function and the differences found between the sexes are like those described in the literature (63–65). This observation reinforces the value of this registry as a population with renal characteristics comparable to other cohorts to be able to carry out collaborative studies.…”

“…These findings can help to identify early clinical and analytical risk factors for worse renal evolution in a differential and more personalized way. The characteristics of the evolution of renal function and the differences found between the sexes are like those described in the literature (63)(64)(65).…”

CKD: The burden of disease invisible to research funders

“…There is mounting evidence that CKD course and complications are not the same in men and women and even that the cut-off points to define CKD may differ. 46 However, we still use the same metric and the same cut-off points to diagnose CKD and for risk stratification in men and women, even knowing that creatinine excretion differs and thus, the denominator for UACR differs for men and for women. RICORS2040 will address the factors behind the gender gap in CKD burden and aims to provide clinical guidance for both men and women and to identify information gaps that preclude a gender-conscious approach to the diagnosis, risk stratification and treatment of CKD.…”