Sex, cardiometabolic risk factors and eGFR decline
The course of chronic kidney disease (CKD), and the health problems associated with it, differ between males and females. Kidney function is known to decline faster among males than females, with males more likely to be treated with kidney replacement therapy (KRT), but females having a higher prevalence of CKD not requiring KRT.
While sex differences in CKD progression have been studied before, the impact of risk factors on decline in kidney function is not well understood. In the present study, the interaction between sex and the association of cardiometabolic risk factors for the decline in kidney function over time was investigated.
A large population-based cohort with extensive blood laboratory test result data and other risk factors was identified from the SAIL Databank in Wales. Included in the analysis were 1,127,731 adults with serum creatinine results, who had not begun KRT when follow-up began. The median age was 59 years (IQI, 46–71), median eGFR was 86.4 mL/min/1.73 m2 (IQI, 71.9–99.1) and the prevalence of cardiometabolic conditions was higher amongst males than females.
Until the age of 73 years, after adjusting for risk factors, the average decline in eGFR per year of −0.83 mL/min/1.73 m2 was found to be similar in males and females. Thereafter, eGFR decline was faster in males than in females.
Heart failure was the risk factor associated with the biggest difference in decline between males and females (−1.22 mL/min/1.73 m2 [95% CI, −1.25 to −1.20] vs −0.87 mL/min/1.73 m2 [−0.89 to −0.85]). In current smokers, the decline was also greater in males than in females (−1.58 mL/min/1.73 m2 [−1.60 to −1.55] vs −1.27 mL/min/1.73 m2 [−1.29 to −1.25]).
Socioeconomic deprivation was an important risk factor associated with eGFR decline, particularly in females >73 years, whereas cardiometabolic risk factors were more important amongst males. The risk of kidney failure was lower in older females at baseline than in older males (P<0.001).
While acknowledging that the study was limited to a predominantly White population, the investigators hope that their findings will inform clinical monitoring and management strategies of CKD overall and within sex-specific groups.
The full article can be read here.
