Sex Differences in the Progression of CKD Among Older Patients: Pooled Analysis of 4 Cohort Studies

Minutolo, Roberto; Gabbai, Francis B.; Chiodini, Paolo; Provenzano, Michele; Borrelli, Silvio; Garofalo, Carlo; Bellizzi, Vincenzo; Russo, Domenico; Conte, Giuseppe; Nicola, Luca De

doi:10.1053/j.ajkd.2019.05.019

Cited by 58 publications

(48 citation statements)

References 42 publications

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“…Norwegian males with ANCA-GN, reported by Bjørneklett et al 14 , were found to have a 2.44-fold increased risk of ESKD (HR 2.44, 95% CI 1.56–3.82, p < 0.001), after adjustment for age, ANCA serology, eGFR, and histological classification. This is consistent with prior observations in all-cause CKD where kidney function declines more rapidly and the risk of ESKD is higher in men 17 , 18 . Data from the Norwegian study was collected between 1991 and 2012 when the standard of care was oral cyclophosphamide.…”

Section: Discussionsupporting

confidence: 93%

A cohort study to investigate sex-specific differences in ANCA-associated glomerulonephritis outcomes

Scott

Canepa

Buettner

et al. 2021

Sci Rep

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Data surrounding sex-specific differences in ANCA-associated vasculitis glomerulonephritis (ANCA-GN) outcomes is sparse. We hypothesised that the previously observed increased risk of end-stage kidney disease (ESKD) in males is driven by sex-specific variation in immunosuppression dosing. Patients were recruited to the Irish Rare Kidney Disease Registry or followed by the Royal Free Hospital vasculitis team (2012–2020). Inclusion criteria: prior diagnosis of ANCA-GN (biopsy proven pauci-immune glomerulonephritis) and positive serology for anti-MPO or -PR3 antibodies. Renal and patient survival, stratified by sex and Berden histological class, was analysed. The cumulative- and starting dose/kilogram of induction agents and prednisolone, respectively, was compared between sexes. 332 patients were included. Median follow-up was time 40.2 months (IQR 17.3–69.2). 73 (22%) reached ESKD and 47 (14.2%) died. Overall 1- and 5-year renal survival was 82.2% and 76.7% in males and 87.1% and 82.0% in females, respectively (p 0.13). The hazard ratio for ESKD in males versus females, after adjustment for age, ANCA serology, baseline creatinine and histological class was 1.07 (95% CI 0.59–1.93). There was no difference between sexes in the dose/kilogram of any induction agent. We did not observe a strong impact of sex on renal outcome in ANCA-GN. Treatment intensity does not vary by sex.

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Section: Discussionsupporting

confidence: 93%

A cohort study to investigate sex-specific differences in ANCA-associated glomerulonephritis outcomes

Scott

Canepa

Buettner

et al. 2021

Sci Rep

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“…Aiming to evaluate these and other clinical outcomes by sex, including to determine differences in treatment and patient characteristics between men and women, we analyzed data from the CKDopps, which systematically captures information from real-world, nephrologist-run CKD clinics. To provide a meaningful addition on top of 3 previous analyses, from the United States, 20 Italy, 21 and Sweden, 22 we emphasized country-specific comparisons. One of the key tasks, before the analysis and sex-specific comparison of outcomes, was to describe the sex-specific prevalence of CKDopps participants at baseline, which was presumed to be a function of patient referral from the general population onto specialized CKD care.…”

mentioning

confidence: 99%

Sex-Specific Differences in Mortality and Incident Dialysis in the Chronic Kidney Disease Outcomes and Practice Patterns Study

Hecking

Zee

et al. 2022

Kidney International Reports

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…37 To the best of our knowledge, no study provides results on gender effects, but it has been proposed that males have poor prognosis of kidney diseases. [38][39][40] Our results suggest that the risk of cardiovascular mortality in elderly men and women who had rapid decline in renal function (eGFR decline <-5 mL/min/1.73 m 2 /year) was, respectively, 2.24 and 1.83 times more than their counterparts. The advantage of our study is that this is a cohort study of elderly persons in Taipei, a major city in Taiwan, which is a large and representative population.…”

Section: Open Accessmentioning

confidence: 68%

Association between renal function and cardiovascular mortality: a retrospective cohort study of elderly from health check-up

et al. 2021

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ObjectivesThis study aimed to investigate the relationship between cardiovascular mortality in elderly Asians and decline in renal function.DesignA retrospective cohort study.SettingCommunity-based health examination database from Taipei city.ParticipantsAt the beginning, the database included 315 045 health check-up visits of 97 803 elderly persons aged ≥65 years old from 2005 to 2012. After excluding missing values and outliers, there were 64 732 elderly persons with at least two visits retained for further analyses.Primary outcome measuresKidney function indicators include estimated glomerular filtration rate (eGFR) and urine protein, and rapid decline in eGFR was defined as slope ≤ −5 mL/min/1.73 m2 per year. The endpoint outcome was defined as the cardiovascular deaths registered in the death registry encoded by the International Classification of Diseases. We applied a Cox proportional hazards model to analyse the association between renal function and cardiovascular mortality.ResultsIn this study, we found 1264 elderly persons died from cardiovascular diseases, for whom the data included 4055 previous health check-up visits. We observed significant and independent associations of eGFR <60 mL/min/1.73 m2 (HR (95% CI) of 60>eGFR≥45 and eGFR<45 in males: 2.85 (1.33 to 6.09) and 3.98 (1.84 to 8.61); in females: 3.66 (1.32 to 10.15) and 6.77 (2.41 to 18.99)), positive proteinuria (HR (95% CI) of +/−, +,++ and +++, ++++ in males: 1.51 (1.29 to 1.78) and 2.31 (1.51 to 3.53); in females: 1.93 (1.54 to 2.42) and 4.23 (2.34 to 7.65)) and rapid decline in eGFR (HR (95% CI) in males: 3.24 (2.73 to 3.85); in females: 2.83 (2.20 to 3.64) with higher risk of cardiovascular mortality. The joint effect of increased concentration of urine protein and reduced eGFR was associated with a higher risk of cardiovascular mortality.ConclusionsRenal function and rapid decline in renal function are independent risk factors for cardiovascular mortality in the elderly.

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Sex Differences in the Progression of CKD Among Older Patients: Pooled Analysis of 4 Cohort Studies

Cited by 58 publications

References 42 publications

A cohort study to investigate sex-specific differences in ANCA-associated glomerulonephritis outcomes

A cohort study to investigate sex-specific differences in ANCA-associated glomerulonephritis outcomes

Sex-Specific Differences in Mortality and Incident Dialysis in the Chronic Kidney Disease Outcomes and Practice Patterns Study

Association between renal function and cardiovascular mortality: a retrospective cohort study of elderly from health check-up

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