Division of Nephrology, University of Campania, Luigi Vanvitelli, Naples, Italy.
Department of Medicine, VA San Diego Healthcare System and University of California at San Diego Medical School, San Diego, CA.
Am J Kidney Dis. 2020 Jan;75(1):30-38. doi: 10.1053/j.ajkd.2019.05.019. Epub 2019 Aug 10.
RATIONALE & OBJECTIVE: Data for the association of sex with chronic kidney disease (CKD) progression are conflicting, a relationship this study sought to examine.
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)<45mL/min/1.73m followed up in renal clinics.
Sex.
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.
Cox proportional hazard analysis to estimate the relative risk for ESKD and mortality and linear mixed models to estimate the rate of eGFR decline.
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/1.73m in women (P<0.001), while median proteinuria was lower in women (protein excretion, 0.45 [IQR, 0.14-1.10] g/d) compared with men (0.69 [IQR 0.19-1.60] g/d; P<0.001). During a median follow-up of 4.2 years, 757 developed ESKD (59.4% men) and 471 died (58.4% men). The adjusted risks for ESKD and mortality were higher in men (HRs of 1.50 [95% CI, 1.28-1.77] and 1.30 [95% CI, 1.06-1.60], respectively). This finding was consistent across CKD stages. We observed a significant interaction between sex and proteinuria, with the risk for ESKD in men being significantly greater than for women at a level of proteinuria of ∼0.5g/d or greater. The slope of decline in eGFR was steeper in men (-2.09; 95% CI, -2.21 to-1.97mL/min/1.73m per year) than in women (-1.79; 95% CI, -1.92 to-1.66mL/min/1.73m per year; P<0.001). Although sex differences in eGFR decline were not different across CKD stages (P=0.3), the difference in slopes between men and women was progressively larger with proteinuria >0.5g/d (P = 0.04).
Residual confounding; only whites were included.
Excess renal risk in men may, at least in part, be related to higher levels of proteinuria in men compared with women.
有关性别与慢性肾脏病（CKD）进展关系的数据存在争议，本研究旨在对此进行探讨。
对 4 项意大利观察性队列研究进行汇总分析。
1311 名年龄较大的男性和 1024 名肾小球滤过率（eGFR）＜45mL/min/1.73m 的年龄较大的女性，在肾脏科接受随访。
性别。
年龄、收缩压和肾素-血管紧张素系统抑制剂的使用在男性和女性之间相似。男性的基线 eGFR 为 27.6±10.2mL/min/1.73m，女性为 26.0±10.6mL/min/1.73m（P＜0.001），而女性的中位蛋白尿较低（蛋白尿排泄量为 0.45[IQR，0.14-1.10]g/d）与男性（0.69[IQR 0.19-1.60]g/d；P＜0.001）。在中位随访 4.2 年后，757 人发生终末期肾病（59.4%为男性），471 人死亡（58.4%为男性）。男性发生终末期肾病和死亡的风险校正后分别为 1.50[95%CI，1.28-1.77]和 1.30[95%CI，1.06-1.60]，高于女性（P＜0.001）。这一发现与 CKD 分期一致。我们观察到性别与蛋白尿之间存在显著的交互作用，在蛋白尿水平约为 0.5g/d 或更高时，男性发生终末期肾病的风险明显高于女性。男性 eGFR 下降的斜率较陡（-2.09；95%CI，-2.21 至-1.97mL/min/1.73m 每年），而女性（-1.79；95%CI，-1.92 至-1.66mL/min/1.73m 每年；P＜0.001）。尽管 eGFR 下降的性别差异在 CKD 分期之间没有差异（P=0.3），但男性和女性之间的斜率差异随着蛋白尿＞0.5g/d 而逐渐增大（P=0.04）。
残余混杂；仅纳入白人。
男性肾脏风险增加，至少部分原因可能与男性蛋白尿水平高于女性有关。
