Department of Internal Medicine, University of Brescia, Brescia, Italy.
J Hypertens. 2012 Dec;30(12):2378-86. doi: 10.1097/HJH.0b013e328359b6a9.
The aim of this study is to evaluate the differences in the prevalence of chronic kidney disease (CKD) and of cardiovascular risk factors and diseases between men and women participating in the Italy Developing Education and awareness on MicroAlbuminuria in patients with hyperteNsive Disease (I-DEMAND) study.
This is an observational, cross-sectional, multicenter study aimed at assessing prevalence and correlates of CKD among Italian hypertensive patients attending out-patient referral clinics. CKD was defined as glomerular filtration rate (GFR) less than 60 ml/min per 1.73 m(2) [Modification of Diet in Renal Disease (MDRD) study equation and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation] and/or urine albumin-to-creatinine ratio of at least 2.5 mg/mmol in men and of at least 3.5 mg/mmol in women or both. Left-ventricular hypertrophy (LVH) was diagnosed by either ECG or echocardiography.
A total of 3558 study patients with renal data available were considered for this analysis: mean age was 61 ± 4 years and 37% had diabetes mellitus. Female patients (n = 1636, 46%) were older, with a greater prevalence of obesity and lower prevalence of smoking. The prevalence of concomitant coronary artery and peripheral artery diseases, but not of hypertension, diabetes mellitus, or heart failure, was lower in women than in men. The overall prevalence of albuminuria (21 vs. 32%; P = 0.001) and of microalbuminuria (16 vs. 23%; P = 0.001) was lower in women than in men. In women the prevalence of a reduced GFR estimated by both MDRD (33 vs. 21%; P = 0.001) and CKD-EPI equations (32 vs. 23%; P = 0.001) was higher than in men. CKD prevalence was similar in women and men (44 vs. 41%; P = 0.095 and 43 vs. 43%; P = 0.475, respectively, when MDRD and CKD-EPI eGFR estimations were used). The prevalence of LVH (diagnosed by either ECG or echocardiography) was similar in men and women (18 vs. 20%; P = 0.12).The main independent determinants of CKD were age, glycemia, uricemia, pulse pressure, hypertension duration, and previous cardiovascular diseases in men, and increasing age, glycemia, uricemia, pulse pressure, and a lower BMI in women.
Renal abnormalities are present in a significant number of female hypertensive patients attending hypertension clinics. Prevalence of reduced eGFR and of microalbuminuria, associated risk factors, and clinical conditions are different between men and women, suggesting the need to develop specific therapeutic strategies to prevent renal dysfunction and reduce associated morbidity and mortality.
本研究旨在评估参加意大利发展教育和提高高血压患者微量白蛋白尿意识（I-DEMAND）研究的男性和女性之间慢性肾脏病（CKD）和心血管风险因素及疾病的患病率差异。
这是一项观察性、横断面、多中心研究，旨在评估意大利高血压门诊就诊患者中 CKD 的患病率和相关因素。CKD 定义为肾小球滤过率（GFR）<60 ml/min/1.73 m²[改良肾脏病饮食研究（MDRD）方程和慢性肾脏病流行病学合作（CKD-EPI）方程]和/或男性尿白蛋白/肌酐比值≥2.5 mg/mmol，女性≥3.5 mg/mmol，或两者均有。左心室肥厚（LVH）通过心电图或超声心动图诊断。
共有 3558 名有肾脏数据的研究患者被纳入本分析：平均年龄为 61±4 岁，37%患有糖尿病。女性患者（n=1636，46%）年龄较大，肥胖患病率较高，吸烟率较低。与男性相比，女性同时患有冠状动脉和外周动脉疾病的患病率较低，但高血压、糖尿病或心力衰竭的患病率较低。女性白蛋白尿（21%比 32%；P=0.001）和微量白蛋白尿（16%比 23%；P=0.001）的总体患病率较低。与男性相比，女性使用 MDRD（33%比 21%；P=0.001）和 CKD-EPI 方程（32%比 23%；P=0.001）估计的 GFR 降低的患病率更高。女性和男性的 CKD 患病率相似（44%比 41%；P=0.095 和 43%比 43%；P=0.475，分别使用 MDRD 和 CKD-EPI eGFR 估计）。男性和女性的 LVH（通过心电图或超声心动图诊断）患病率相似（18%比 20%；P=0.12）。男性 CKD 的主要独立决定因素是年龄、血糖、尿酸、脉压、高血压持续时间和既往心血管疾病，而女性则是年龄增加、血糖、尿酸、脉压和 BMI 降低。
在参加高血压门诊的女性高血压患者中，存在大量的肾脏异常。与男性相比，女性的肾小球滤过率降低和微量白蛋白尿的患病率、相关危险因素和临床情况不同，这表明需要制定特定的治疗策略来预防肾功能障碍并降低相关发病率和死亡率。
