Risk factors of gender for renal progression in patients with early chronic kidney disease

Abstract

Risk factors for chronic kidney disease (CKD), such as hypertension, hyperglycemia, albuminuria, renal structure, and sex hormones, have been reported to have different effects on males and females. Thus, CKD progression may differ depending on sex. In addition to CKD management, treatment at earlier stages can reduce complications and prevent disease progression as well as high medical expenses at late stages. We examined the differences in predictive risk factors for renal progression between male and female patients with early CKD.This case–cohort study recruited patients aged 18 years or older treated in the outpatient departments of 8 hospitals in Taiwan between August 2008 and September 2014. In total, 1530 patients were included in the analysis. Renal progression was defined as ≥25% decline based on baseline estimated glomerular filtration rate. To examine the predictive risk factors for renal progression, we constructed a subset multivariate logistic model with stepwise variable selection by using P < 0.10 for variable retention.The numbers of male and female patients with CKD exhibiting renal progression were 100 (11.64%) and 84 (12.52%), respectively. After adjusting for all the potential confounders, stepwise logistic regression analysis showed that main independent predictive risk factors for the male patients– (C statistic = 0.72) were proteinuria (odds ratio [OR] 2.20; 95% confidence interval [CI] 1.26–3.84), age (OR 1.04; 95% CI 1.02–1.06), anemia (OR 2.75; 95% CI 1.20–6.30), and poor control of blood pressure (OR 1.84; 95% CI 1.05–3.22). However, the main independent predictive factors for the female patients were (C statistic = 0.75) poor glycemic control (OR 2.28; 95% CI 1.22–4.25), poor blood pressure control (OR 1.93; 95% CI 1.06–3.50), and family income (OR 2.51; 95% CI 1.01–6.20).In conclusion, this study demonstrated that proteinuria was the most crucial risk factor for male patients, whereas poor glycemic control was the main risk factor for female patients. Poor blood pressure control was a shared risk factor for male and female patients.

Elevated serum levels of procollagen C‐proteinase enhancer‐1 in patients with chronic kidney disease is associated with a declining glomerular filtration rate

“…Blood pressure elevation is one of the most effective risk factors for both development of CKD and for the progression of the disease. 3,19,20 In our study, PCPE-1 levels in the CKD patient group with uncontrolled BP were significantly higher than those in the control group. Positive correlation was determined between SBP and PCPE-1 in the patient group as a whole, but separate correlation analyses among patients with controlled and uncontrolled BP revealed no significant relation between SBP and PCPE-1.…”

“…Blood pressure elevation is one of the most effective risk factors for both development of CKD and for the progression of the disease . In our study, PCPE‐1 levels in the CKD patient group with uncontrolled BP were significantly higher than those in the control group.…”

Impact of sex on diabetic nephropathy and the renal transcriptome in UNx db/db C57BLKS mice

“…Accordingly, to accelerate the progression of DN, and hence to more closely mimic human pathophysiology, unilateral nephrectomy can be applied leading to additional hemodynamic stress on the remaining kidney (Bower, Brown, Steffes, Vernier, & Mauer, 1980). Despite evidence of sex-associated differences in the progression of DN in human patients (Carrero, Hecking, Chesnaye, & Jager, 2018;Chang et al, 2016;Piccoli, Alrukhaimi, Liu, Zakharova, & Levin, 2018), male mice are predominantly being used in preclinical DN research and drug development including the majority of previous studies in the UNx db/db mouse model of DN (Ninichuk, Khandoga, et al, 2007;Ninichuk, Kulkarni, Clauss, & Anders, 2007;Senador, Kanakamedala, Irigoyen, Morris, & Elased, 2009;Yiu et al, 2016). In this study, we therefore compared the progression of DN in male and female UNx db/db C57BLKS mice using standard biochemical and histological endpoints, as well as renal cortex transcriptomic changes.…”

High Level of Physical Activity Reduces the Risk of Renal Progression in Hypertensive Patients

“…Previous studies have proposed that men show a lower risk of CKD with higher levels of vigorous intensity physical activity compared with women, while shorter sitting times are associated with CKD in women, but not in men [26]. A possible explanation for this finding is that cultural and social environmental differences and biological effects have caused sex differences [35][36][37]. It has been reported that estrogens may bring into play potent antioxidant action and may have protective effects on renal progression in women [38].…”