Nicholas C Chesnaye1, Friedo W Dekker2, Marie Evans3, Fergus J Caskey4, Claudia Torino5, Maurizio Postorino5, Maciej Szymczak6, Chava L Ramspek2, Christiane Drechsler7, Christoph Wanner7, Kitty J Jager1. 1. ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands. 2. Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands. 3. Renal Unit, Department of Clinical Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden. 4. Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK. 5. IFC-CNR, Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension and G.O.M., Bianchi Melacrino Morelli, Reggio Calabria, Italy. 6. Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland. 7. Division of Nephrology, University Hospital of Wurzburg, Wurzburg, Germany.
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.
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 CKDpatients ≥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.
Authors: Nicholas C Chesnaye; Yvette Meuleman; Esther N M de Rooij; Ellen K Hoogeveen; Friedo W Dekker; Marie Evans; Agneta A Pagels; Fergus J Caskey; Claudia Torino; Gaetana Porto; Maciej Szymczak; Christiane Drechsler; Christoph Wanner; Kitty J Jager Journal: Clin J Am Soc Nephrol Date: 2022-01-24 Impact factor: 8.237
Authors: Elke S Schaeffner; Natalie Ebert; Martin K Kuhlmann; Peter Martus; Nina Mielke; Alice Schneider; Markus van der Giet; Dörte Huscher Journal: Clin J Am Soc Nephrol Date: 2022-07-18 Impact factor: 10.614