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. 2021 Aug 27;36(9):1656-1663.
doi: 10.1093/ndt/gfaa095.

Renal function decline in older men and women with advanced chronic kidney disease-results from the EQUAL study

Nicholas C Chesnaye  1 , Friedo W Dekker  2 , Marie Evans  3 , Fergus J Caskey  4 , Claudia Torino  5 , Maurizio Postorino  5 , Maciej Szymczak  6 , Chava L Ramspek  2 , Christiane Drechsler  7 , Christoph Wanner  7 , Kitty J Jager  1
Affiliations

Renal function decline in older men and women with advanced chronic kidney disease-results from the EQUAL study

Nicholas C Chesnaye et al. Nephrol Dial Transplant. .

Abstract

Introduction: Understanding the mechanisms underlying the differences in renal decline between men and women may improve sex-specific clinical monitoring and management. To this end, we aimed to compare the slope of renal function decline in older men and women in chronic kidney disease (CKD) Stages 4 and 5, taking into account informative censoring related to the sex-specific risks of mortality and dialysis initiation.

Methods: The European QUALity Study on treatment in advanced CKD (EQUAL) study is an observational prospective cohort study in Stages 4 and 5 CKD patients ≥65 years not on dialysis. Data on clinical and demographic patient characteristics were collected between April 2012 and December 2018. Estimated glomerular filtration rate (eGFR) was calculated using the CKD Epidemiology Collaboration equation. eGFR trajectory by sex was modelled using linear mixed models, and joint models were applied to deal with informative censoring.

Results: We included 7801 eGFR measurements in 1682 patients over a total of 2911 years of follow-up. Renal function declined by 14.0% [95% confidence interval (CI) 12.9-15.1%] on average each year. Renal function declined faster in men (16.2%/year, 95% CI 15.9-17.1%) compared with women (9.6%/year, 95% CI 6.3-12.1%), which remained largely unchanged after accounting for various mediators and for informative censoring due to mortality and dialysis initiation. Diabetes was identified as an important determinant of renal decline specifically in women.

Conclusion: In conclusion, renal function declines faster in men compared with women, which remained similar after adjustment for mediators and despite a higher risk of informative censoring in men. We demonstrate a disproportional negative impact of diabetes specifically in women.

Keywords: EQUAL; renal function decline; sex disparities.

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Figures

FIGURE 1
FIGURE 1
(a) The average eGFR trajectory by sex with 95% CIs. (b) The average eGFR trajectory by sex (LMM) adjusted for censoring due to death (JM: Death) and dialysis (JM: Dialysis). The adjusted trajectories represent the average eGFR trajectory in the hypothetical situation that all patients had remained alive/had not started dialysis. The top group of lines corresponds to the eGFR trajectory in women and the bottom lines to that in men.
FIGURE 2
FIGURE 2
(a) Effect modification by age on renal function decline by sex. (b) Effect modification by diabetes on renal function decline by sex.
See this image and copyright information in PMC

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