Kidney Function, Kidney Replacement Therapy, and Mortality in Men and Women
Introduction: Women are more likely to have chronic kidney disease (CKD), compared with men, yet they are less likely to receive dialysis. Whether this sex disparity, which has predominantly been observed in nephrology-referred or CKD-specific cohorts so far, has a biological root cause remains uncl...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-03-01
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| Series: | Kidney International Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2468024921016144 |
| _version_ | 1828426753700265984 |
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| author | Sebastian Hödlmoser Juan Jesus Carrero Amelie Kurnikowski Edouard L. Fu Oskar Swartling Wolfgang C. Winkelmayer Eva S. Schernhammer Manfred Hecking |
| author_facet | Sebastian Hödlmoser Juan Jesus Carrero Amelie Kurnikowski Edouard L. Fu Oskar Swartling Wolfgang C. Winkelmayer Eva S. Schernhammer Manfred Hecking |
| author_sort | Sebastian Hödlmoser |
| collection | DOAJ |
| description | Introduction: Women are more likely to have chronic kidney disease (CKD), compared with men, yet they are less likely to receive dialysis. Whether this sex disparity, which has predominantly been observed in nephrology-referred or CKD-specific cohorts so far, has a biological root cause remains unclear. Methods: We extracted general population data from the Stockholm CREAtinine Measurements project (SCREAM) (N = 496,097 participants, 45.5% men, 54.5% women). We used Cox regression to model male-to-female cause-specific hazard ratios (csHRs) for the competing events kidney replacement therapy (KRT, by dialysis or transplantation) and pre-KRT death, adjusted for baseline age, baseline kidney function (assessed via estimated glomerular filtration rate [eGFR] and eGFR slope), and comorbidities. Furthermore, we modeled sex-specific all-cause mortality by eGFR, again adjusted for age, eGFR slope, and comorbidities at baseline. Results: Compared with women, men were significantly more likely to receive KRT (fully adjusted male-to-female csHR for KRT 1.41 [95% CI 1.13–1.76]) but also more likely to experience pre-KRT death (csHR 1.36 [95% CI 1.33–1.38]). Differences between men and women regarding all-cause mortality by eGFR indicated a higher mortality in men at low eGFR values. Conclusion: Our data show that sex differences in CKD outcomes persist even after controlling for important comorbidities and kidney function at baseline. While future studies with a wider range of biological factors are warranted, these data suggest that nonbiological factors may be more important in explaining existing sex disparities in CKD progression and therapy. |
| first_indexed | 2024-12-10T16:50:59Z |
| format | Article |
| id | doaj.art-11b4767431dd4eee82550b9803a5f4bd |
| institution | Directory Open Access Journal |
| issn | 2468-0249 |
| language | English |
| last_indexed | 2024-12-10T16:50:59Z |
| publishDate | 2022-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Kidney International Reports |
| spelling | doaj.art-11b4767431dd4eee82550b9803a5f4bd2022-12-22T01:40:53ZengElsevierKidney International Reports2468-02492022-03-0173444454Kidney Function, Kidney Replacement Therapy, and Mortality in Men and WomenSebastian Hödlmoser0Juan Jesus Carrero1Amelie Kurnikowski2Edouard L. Fu3Oskar Swartling4Wolfgang C. Winkelmayer5Eva S. Schernhammer6Manfred Hecking7Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria; Clinical Division of Nephrology & Dialysis, Department of Internal Medicine III, Medical University of Vienna, Vienna, AustriaDepartment of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, SwedenClinical Division of Nephrology & Dialysis, Department of Internal Medicine III, Medical University of Vienna, Vienna, AustriaDepartment of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The NetherlandsClinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, SwedenSection of Nephrology, Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, Texas, USADepartment of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA; Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Massachusetts, USAClinical Division of Nephrology & Dialysis, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; Correspondence: Manfred Hecking, Division of Nephrology and Dialysis, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.Introduction: Women are more likely to have chronic kidney disease (CKD), compared with men, yet they are less likely to receive dialysis. Whether this sex disparity, which has predominantly been observed in nephrology-referred or CKD-specific cohorts so far, has a biological root cause remains unclear. Methods: We extracted general population data from the Stockholm CREAtinine Measurements project (SCREAM) (N = 496,097 participants, 45.5% men, 54.5% women). We used Cox regression to model male-to-female cause-specific hazard ratios (csHRs) for the competing events kidney replacement therapy (KRT, by dialysis or transplantation) and pre-KRT death, adjusted for baseline age, baseline kidney function (assessed via estimated glomerular filtration rate [eGFR] and eGFR slope), and comorbidities. Furthermore, we modeled sex-specific all-cause mortality by eGFR, again adjusted for age, eGFR slope, and comorbidities at baseline. Results: Compared with women, men were significantly more likely to receive KRT (fully adjusted male-to-female csHR for KRT 1.41 [95% CI 1.13–1.76]) but also more likely to experience pre-KRT death (csHR 1.36 [95% CI 1.33–1.38]). Differences between men and women regarding all-cause mortality by eGFR indicated a higher mortality in men at low eGFR values. Conclusion: Our data show that sex differences in CKD outcomes persist even after controlling for important comorbidities and kidney function at baseline. While future studies with a wider range of biological factors are warranted, these data suggest that nonbiological factors may be more important in explaining existing sex disparities in CKD progression and therapy.http://www.sciencedirect.com/science/article/pii/S2468024921016144kidney replacement therapy initiationmortality in the predialysis stagesex and gender disparitysex/gender differences in nephrology |
| spellingShingle | Sebastian Hödlmoser Juan Jesus Carrero Amelie Kurnikowski Edouard L. Fu Oskar Swartling Wolfgang C. Winkelmayer Eva S. Schernhammer Manfred Hecking Kidney Function, Kidney Replacement Therapy, and Mortality in Men and Women Kidney International Reports kidney replacement therapy initiation mortality in the predialysis stage sex and gender disparity sex/gender differences in nephrology |
| title | Kidney Function, Kidney Replacement Therapy, and Mortality in Men and Women |
| title_full | Kidney Function, Kidney Replacement Therapy, and Mortality in Men and Women |
| title_fullStr | Kidney Function, Kidney Replacement Therapy, and Mortality in Men and Women |
| title_full_unstemmed | Kidney Function, Kidney Replacement Therapy, and Mortality in Men and Women |
| title_short | Kidney Function, Kidney Replacement Therapy, and Mortality in Men and Women |
| title_sort | kidney function kidney replacement therapy and mortality in men and women |
| topic | kidney replacement therapy initiation mortality in the predialysis stage sex and gender disparity sex/gender differences in nephrology |
| url | http://www.sciencedirect.com/science/article/pii/S2468024921016144 |
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