Renal function decline in older men and women with advanced chronic kidney disease—results from the EQUAL study

Author:

Chesnaye Nicholas C1,Dekker Friedo W2,Evans Marie3ORCID,Caskey Fergus J4,Torino Claudia5,Postorino Maurizio5,Szymczak Maciej6,Ramspek Chava L2ORCID,Drechsler Christiane7,Wanner Christoph7,Jager Kitty J1

Affiliation:

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

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.

Funder

European Renal Association–European Dialysis and Transplant Association

Swedish Medical Association

Stockholm County Council ALF

Italian Society of Nephrology

Dutch Kidney Foundation

National Institute for Health Research

NIHR

Publisher

Oxford University Press (OUP)

Subject

Transplantation,Nephrology

Reference51 articles.

1. Kidney disease and renal function;Roth

2. Trends in prevalence of chronic kidney disease in the United States;Murphy;Ann Intern Med,2016

3. Prevalence of chronic kidney disease in Thai adults: a national health survey;Ong-Ajyooth;BMC Nephrol,2009

4. Prevalence and recognition of chronic kidney disease in Stockholm healthcare;Gasparini;Nephrol Dial Transplant,2016

5. AUSDIAB 2012: the Australian diabetes, obesity and lifestyle study;Tanamas,2013

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