Sex Differences in the Progression of CKD Among Older Patients: Pooled Analysis of 4 Cohort Studies

Rationale & Objective Data for the association of sex with chronic kidney disease (CKD) progression are conflicting, a relationship this study sought to examine. Study Design Pooled analysis of 4 Italian observational cohort studies. Setting & Participants 1,311 older men and 1,024 older women with estimated glomerular filtration rate (eGFR) Predictor Sex. Outcomes End-stage kidney disease (ESKD), defined as maintenance dialysis or kidney transplantation, as the primary outcome; all-cause mortality and eGFR decline as secondary outcomes. Analytical Approach Cox proportional hazard analysis to estimate the relative risk for ESKD and mortality and linear mixed models to estimate the rate of eGFR decline. Results Age, systolic blood pressure, and use of renin-angiotensin system inhibitors were similar in men and women. Baseline eGFRs were 27.6±10.2 in men and 26.0±10.6mL/min/1.73m2 in women (P 0.5g/d (P = 0.04). Limitations Residual confounding; only whites were included. Conclusions Excess renal risk in men may, at least in part, be related to higher levels of proteinuria in men compared with women.