Sex-Related Disparities in CKD Progression

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.

Graphical abstract

Figure 1.

Unadjusted rates of ESRD and death were lower in women compared with men across age strata. Unadjusted (A) ESRD and (B) death event rates per 100 person-years of follow-up in women (light gray) versus men (dark gray) stratified by age.

Figure 2.

Adjusted eGFR slope was similar in women compared with men. Mixed effects models for the difference in eGFR slope in women versus men using a hierarchical modeling approach similar to failure-time regression analyses.