Oskar Swartling1, Helena Rydell2, Maria Stendahl3, Mårten Segelmark4, Ylva Trolle Lagerros5, Marie Evans2. 1. Department of Medicine, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden. Electronic address: oskar.swartling@ki.se. 2. Renal unit, Department of Clinical Sciences, Interventions and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Swedish Renal Registry, Department of Internal Medicine, Ryhov Regional Hospital, Jönköping, Sweden. 3. Swedish Renal Registry, Department of Internal Medicine, Ryhov Regional Hospital, Jönköping, Sweden. 4. Swedish Renal Registry, Department of Internal Medicine, Ryhov Regional Hospital, Jönköping, Sweden; Department of Clinical Sciences, Division of Nephrology, Lund University and Skane University Hospital, Lund, Sweden. 5. Department of Medicine, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden; Center for Obesity, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden.
Abstract
RATIONALE & OBJECTIVE: Chronic kidney disease (CKD) is a global health problem with increasing prevalence. Several sex-specific differences have been reported for disease progression and mortality. Selection and survival bias might have influenced the results of previous cohort studies. The objective of this study was to investigate sex-specific differences of CKD progression and mortality among patients with CKD not receiving maintenance dialysis. STUDY DESIGN: Observational cohort study. SETTING & PARTICIPANTS: Adult patients with incident CKD glomerular filtration rate categories 3b to 5 (G3b-G5) identified between 2010 and 2018 within the nationwide Swedish Renal Registry-CKD (SRR-CKD). EXPOSURE: Sex. OUTCOMES: Time to CKD progression (defined as a change of at least 1 CKD stage or initiation of kidney replacement therapy [KRT]) or death. Repeated assessments of estimated glomerular filtration rate (eGFR). ANALYTICAL APPROACH: CKD progression and mortality before KRT were assessed by the cumulative incidence function methods and Fine and Gray models, with death handled as a competing event. Sex differences in eGFR slope were estimated using mixed effects linear regression models. RESULTS: 7,388 patients with incident CKD G3b, 18,282 with incident CKD G4, and 9,410 with incident CKD G5 were identified. Overall, 19.6 (95% CI, 19.2-20.0) patients per 100 patient-years progressed, and 10.1 (95% CI, 9.9-10.3) patients per 100 person-years died. Women had a lower risk of CKD progression (subhazard ratio [SHR], 0.88 [95% CI, 0.85-0.92]), and a lower all-cause (SHR, 0.90 [95% CI, 0.85-0.94]) and cardiovascular (SHR, 0.83 [95% CI, 0.76-0.90]) mortality risk. Risk factors related to a steeper decline in eGFR included age, sex, albuminuria, and type of primary kidney disease. LIMITATIONS: Incomplete data for outpatient visits and laboratory measurements and regional differences in reporting. CONCLUSIONS: Compared to women, men had a higher rate of all-cause and cardiovascular mortality, an increased risk of CKD progression, and a steeper decline in eGFR.
RATIONALE & OBJECTIVE:Chronic kidney disease (CKD) is a global health problem with increasing prevalence. Several sex-specific differences have been reported for disease progression and mortality. Selection and survival bias might have influenced the results of previous cohort studies. The objective of this study was to investigate sex-specific differences of CKD progression and mortality among patients with CKD not receiving maintenance dialysis. STUDY DESIGN: Observational cohort study. SETTING & PARTICIPANTS: Adult patients with incident CKD glomerular filtration rate categories 3b to 5 (G3b-G5) identified between 2010 and 2018 within the nationwide Swedish Renal Registry-CKD (SRR-CKD). EXPOSURE: Sex. OUTCOMES: Time to CKD progression (defined as a change of at least 1 CKD stage or initiation of kidney replacement therapy [KRT]) or death. Repeated assessments of estimated glomerular filtration rate (eGFR). ANALYTICAL APPROACH: CKD progression and mortality before KRT were assessed by the cumulative incidence function methods and Fine and Gray models, with death handled as a competing event. Sex differences in eGFR slope were estimated using mixed effects linear regression models. RESULTS: 7,388 patients with incident CKD G3b, 18,282 with incident CKD G4, and 9,410 with incident CKD G5 were identified. Overall, 19.6 (95% CI, 19.2-20.0) patients per 100 patient-years progressed, and 10.1 (95% CI, 9.9-10.3) patients per 100 person-years died. Women had a lower risk of CKD progression (subhazard ratio [SHR], 0.88 [95% CI, 0.85-0.92]), and a lower all-cause (SHR, 0.90 [95% CI, 0.85-0.94]) and cardiovascular (SHR, 0.83 [95% CI, 0.76-0.90]) mortality risk. Risk factors related to a steeper decline in eGFR included age, sex, albuminuria, and type of primary kidney disease. LIMITATIONS: Incomplete data for outpatient visits and laboratory measurements and regional differences in reporting. CONCLUSIONS: Compared to women, men had a higher rate of all-cause and cardiovascular mortality, an increased risk of CKD progression, and a steeper decline in eGFR.
Authors: Oskar Swartling; Yuanhang Yang; Catherine M Clase; Edouard L Fu; Manfred Hecking; Sebastian Hödlmoser; Ylva Trolle-Lagerros; Marie Evans; Juan J Carrero Journal: J Am Soc Nephrol Date: 2022-07-29 Impact factor: 14.978
Authors: María José Pérez-Sáez; Carlos E Arias-Cabrales; Vanesa Dávalos-Yerovi; Dolores Redondo; Anna Faura; María Vera; Anna Bach; Guillermo Pedreira; Ernestina Junyent; Marta Crespo; Ester Marco; Leocadio Rodríguez-Mañas; Julio Pascual Journal: Clin Kidney J Date: 2021-07-10
Authors: Manfred Hecking; Charlotte Tu; Jarcy Zee; Brian Bieber; Sebastian Hödlmoser; Helmut Reichel; Ricardo Sesso; Friedrich K Port; Bruce M Robinson; Juan Jesus Carrero; Allison Tong; Christian Combe; Bénédicte Stengel; Roberto Pecoits-Filho Journal: Kidney Int Rep Date: 2021-12-01
Authors: Sebastian Hödlmoser; Juan Jesus Carrero; Amelie Kurnikowski; Edouard L Fu; Oskar Swartling; Wolfgang C Winkelmayer; Eva S Schernhammer; Manfred Hecking Journal: Kidney Int Rep Date: 2021-12-27