A study of patients with moderate to severe chronic kidney disease (CKD) found that women are at lower risk for disease progression and all-cause and cardiovascular (CV) mortality compared with men, according to a recent report.

The findings are from analyses of 10-year data (2008 to 2018) from a Swedish nationwide population-based registry. The study population included 7388, 18,282, and 9410 patients with incident CKD stages G3b, G4, and G5, respectively.

Overall, 19.6 patients per 100 person-years had CKD progression and 10.1 patients per 100 person-years died, Oskar Swartling, MD, of the Karolinska Institutet in Stockholm, Sweden, and colleagues reported online in the American Journal of Kidney Diseases. The rate of CKD progression was 20.8 patients per 100 person-years for men compared with 17.6 patients per 100 person-years for women. The all-cause mortality rate was 10.6 deaths per 100 person-years for men compared with 9.2 deaths per 100 person-years for women.

The overall CV mortality rate was 3.79 per 100 person-years, but was lower for women than men across CKD stages. The CV death rates per 100 person-years for patients with CKD 3b, G4, and G5 were 1.4, 2.4, and 5.1, respectively, for women, compared with 1.8, 3.8, and 5.8, respectively, for men.


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Overall, compared with men, women had a significant 12%, 10%, and 17% decreased risk for CKD progression, all-cause mortality, and CV mortality, respectively, in adjusted analyses.

The study also identified risk factors for progression, including increasing age and albuminuria. Compared with patients younger than 55 years, those aged 55 to 64, 65 to 70, 70 to 75, 75 to 80, and older than 80 years, respectively, had a 30%, 39%, 46%, 51%, and 64% increased risk of progressing by 1 CKD stage or starting kidney replacement therapy in adjusted analyses.

Compared with an albumin:creatinine ratio (ACR) less than 26.55 mg/g, ACR values of 26.55 to 265.49 and more than 265.49 mg/g were significantly associated with 1.3- and 2.8-fold increased risks for progression, respectively.

The risk of progression also varied by renal diagnosis. Compared with glomerulonephritis, nephrosclerosis and tubule-interstitial nephritis were significantly associated with a 22% and 31% decreased risk for progression, respectively, whereas diabetic kidney disease was significantly associated with a 30% increased risk for progression.

“Understanding of factors associated with a higher rate of disease progression is important to identify, so that preventive measures may be taken,” the authors concluded.

Reference

Swartling O, Rydell H, Stendahl M, et al. CKD progression and mortality among men and women: A nationwide study in Sweden. Published online January 9, 2021. Am J Kidney Dis. doi:10.1053/j.ajkd.2020.11.026