Background: There is substantial clinical uncertainty as to whether the associations of chronic kidney disease (CKD) with mortality and end-stage renal disease (ESRD) differ between men and women. Objective: To assess for the presence of a gender interaction in the associations of estimated glomerular filtration rate (eGFR) and albuminuria with all-cause mortality, cardiovascular mortality and ESRD. Design: Random-effects meta-analysis using pooled individual participant data. Setting: 46 cohorts from Europe, North and South America, Asia and Australasia. Participants: 2,051,158 participants (54% women) from general population (n=1,861,052), high-risk (n=151,494), and CKD (n=38,612) cohorts. Eligible cohorts (except CKD cohorts) had at least 1000 participants, outcomes of either mortality or ESRD of ≥50 events, and baseline measurements of CKD-EPI eGFR (mL/min/1.73m2), urinary albumin-creatinine ratio (ACR; mg/g). Results: All-cause and cardiovascular mortality risk was higher in men at all levels of eGFR and ACR. While higher risk was associated with lower eGFR and higher ACR in both genders, the slope of the risk relationship for all-cause and cardiovascular mortality was steeper in women than in men. Compared with eGFR 95, the adjusted hazard ratio (HR) for all-cause mortality at eGFR 45 was 1.32 (95% CI, 1.08 to 1.61) in women and 1.22 (CI, 1.00 to 1.48) in men (p for interaction <0.01). Compared with ACR 5, the HR for all-cause mortality at ACR 30 was 1.69 (CI, 1.54 to 1.84) in women and 1.43 (CI, 1.31 to 1.57) in men (p for interaction<0.01). Conversely, there was no evidence of a gender difference in associations of eGFR and ACR with ESRD risk. Conclusions: Both genders face increased risk of all-cause and cardiovascular mortality and ESRD with lower eGFR and higher albuminuria. These findings were robust across a large global consortium.
Associations of estimated glomerular filtration rate and albuminuria with mortality and renal failure by sex: a meta-analysis.
M. Cirillo
;
2013-01-01
Abstract
Background: There is substantial clinical uncertainty as to whether the associations of chronic kidney disease (CKD) with mortality and end-stage renal disease (ESRD) differ between men and women. Objective: To assess for the presence of a gender interaction in the associations of estimated glomerular filtration rate (eGFR) and albuminuria with all-cause mortality, cardiovascular mortality and ESRD. Design: Random-effects meta-analysis using pooled individual participant data. Setting: 46 cohorts from Europe, North and South America, Asia and Australasia. Participants: 2,051,158 participants (54% women) from general population (n=1,861,052), high-risk (n=151,494), and CKD (n=38,612) cohorts. Eligible cohorts (except CKD cohorts) had at least 1000 participants, outcomes of either mortality or ESRD of ≥50 events, and baseline measurements of CKD-EPI eGFR (mL/min/1.73m2), urinary albumin-creatinine ratio (ACR; mg/g). Results: All-cause and cardiovascular mortality risk was higher in men at all levels of eGFR and ACR. While higher risk was associated with lower eGFR and higher ACR in both genders, the slope of the risk relationship for all-cause and cardiovascular mortality was steeper in women than in men. Compared with eGFR 95, the adjusted hazard ratio (HR) for all-cause mortality at eGFR 45 was 1.32 (95% CI, 1.08 to 1.61) in women and 1.22 (CI, 1.00 to 1.48) in men (p for interaction <0.01). Compared with ACR 5, the HR for all-cause mortality at ACR 30 was 1.69 (CI, 1.54 to 1.84) in women and 1.43 (CI, 1.31 to 1.57) in men (p for interaction<0.01). Conversely, there was no evidence of a gender difference in associations of eGFR and ACR with ESRD risk. Conclusions: Both genders face increased risk of all-cause and cardiovascular mortality and ESRD with lower eGFR and higher albuminuria. These findings were robust across a large global consortium.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
