TY - JOUR
T1 - Renal function decline in older men and women with advanced chronic kidney disease-results from the EQUAL study
AU - Chesnaye, Nicholas C.
AU - Dekker, Friedo W.
AU - Evans, Marie
AU - Caskey, Fergus J.
AU - Torino, Claudia
AU - Postorino, Maurizio
AU - Szymczak, MacIej
AU - Ramspek, Chava L.
AU - Drechsler, Christiane
AU - Wanner, Christoph
AU - Jager, Kitty J.
N1 - Publisher Copyright: © 2020 The Author(s). Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.
PY - 2021/9/1
Y1 - 2021/9/1
N2 - 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.
AB - 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.
KW - EQUAL
KW - renal function decline
KW - sex disparities
UR - http://www.scopus.com/inward/record.url?scp=85109818013&partnerID=8YFLogxK
U2 - https://doi.org/10.1093/ndt/gfaa095
DO - https://doi.org/10.1093/ndt/gfaa095
M3 - Article
C2 - 32591814
SN - 0931-0509
VL - 36
SP - 1656
EP - 1663
JO - Nephrology, dialysis, transplantation
JF - Nephrology, dialysis, transplantation
IS - 9
ER -