Kidney Function, Kidney Replacement Therapy, and Mortality in Men and Women

• Main Authors: Carrero, J.J (Author), Fu, E.L (Author), Hecking, M. (Author), Hödlmoser, S. (Author), Kurnikowski, A. (Author), Schernhammer, E.S (Author), Swartling, O. (Author), Winkelmayer, W.C (Author)
• Format: Article
• Language: English
• Published: Elsevier Inc. 2022
• Subjects: adult; alcohol abuse; all cause mortality; anemia; Article; bleeding; blood clotting disorder; cardiovascular disease; chronic kidney failure; chronic lung disease; comorbidity; congestive heart failure; controlled study; creatinine; depression; diabetes mellitus; drug abuse; estimated glomerular filtration rate; female; heart arrhythmia; human; human tissue; hypertension; hypothyroidism; kidney function; kidney replacement therapy initiation; liver disease; lymphoma; major clinical study; male; malignant neoplasm; metastasis; mortality in the predialysis stage; neurologic disease; obesity; paralysis; peptic ulcer; peripheral vascular disease; psychosis; renal replacement therapy; rheumatoid arthritis; sex and gender disparity; sex difference; sex/gender differences in nephrology; solid malignant neoplasm; vascular disease
• Online Access: View Fulltext in Publisher

 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. © 2021 International Society of Nephrology