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Proteinuria may contribute to greater risk for CKD progression in men than women
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Older men with chronic kidney disease had a 50% increased risk for progression to ESKD compared with women and this may be the result of higher levels of proteinuria, according to a recently published study.
“In the era of precision medicine, gaining sex-specific data is a necessary step to correctly implement individualized treatment,” Roberto Minutolo, MD, PhD, of the division of nephrology at the University of Campania in Italy, and colleagues wrote. “The importance of sexual dimorphisms has been observed for hypertension and cardiovascular complications with regard to disease presentation, likelihood of progression to advanced phases and response to treatment. To date, the impact of sex on CKD remains poorly defined. In this setting, the mechanisms underlying the observed sex disparity in the epidemiology of kidney diseases have not been fully elucidated.”
To evaluate the impact of sex on CKD progression, researchers conducted a pooled analysis of four observational cohort studies, which included a total of 2,335 men and women with an eGFR of less than 45 mL/min/1.73m2 (mean age, 67.1 years; mean eGFR, 26.9 mL/min/1.73m2). While age, systolic blood pressure and use of renin-angiotensin system inhibitors were similar between men and women, women had a lower median proteinuria (protein excretion, 0.45 g/d) compared with men (0.69 g/d).
The primary outcome of the study was the development of ESKD (defined as maintenance dialysis or kidney transplantation). Secondary outcomes included all-cause mortality and eGFR decline.
Patients were followed for a median of 4.2 years. During this time, 471 participants died (58.4% of these were men) and 757 developed ESKD (59.4% were men).
Researchers found the adjusted risks for both mortality and ESKD were higher for men (HR = 1.30 and HR = 1.50, respectively) than women and that this finding was consistent regardless of CKD stage.
In addition, researchers observed that men had a significantly higher risk for ESKD than women when their level of proteinuria was approximately 0.50 g/d or greater. When examining eGFR, researchers concluded that the slope of decline in eGFR was steeper in men than in women and that the difference in slopes between men and women was progressively larger with proteinuria less than 0.50 g/d.
“Data were obtained from patients with clinical features consistent with the epidemiologic pattern of the present CKD population worldwide, namely advanced age and high prevalence of diabetes and cardiovascular disease,” the researchers wrote. “[Still], our study has some limitations, [including that] the results derive from a population of referred white patients with CKD and therefore findings may not hold true for other ethnic groups. [Despite this limitation], proteinuria levels may modify the association between sex and renal risk.” – by Melissa J. Webb
Disclosures: The authors report no relevant financial disclosures.
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