Department of Biomedical Science, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.
Department of Health Systems and Populations, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.
PLoS One. 2021 Jul 12;16(7):e0254554. doi: 10.1371/journal.pone.0254554. eCollection 2021.
Chronic kidney disease (CKD) is a significant health challenge associated with high cardiovascular mortality risk. Historically, cardiovascular mortality risk has been found to higher in men than women in the general population. However, recent research has highlighted that this risk may be similar or even higher in women than men in the CKD population. To address the inconclusive and inconsistent evidence regarding this relationship between sex and cardiovascular mortality within CKD patients, a systematic review and meta-analysis of articles published between January 2004 and October 2020 using PubMed/Medline, EMBASE, Scopus and Cochrane databases was performed. Forty-eight studies were included that reported cardiovascular mortality among adult men relative to women with 95% confidence intervals (CI) or provided sufficient data to calculate risk estimates (RE). Random effects meta-analysis of reported and calculated estimates revealed that male sex was associated with elevated cardiovascular mortality in CKD patients (RE 1.13, CI 1.03-1.25). Subsequent subgroup analyses indicated higher risk in men in studies based in the USA and in men receiving haemodialysis or with non-dialysis-dependent CKD. Though men showed overall higher cardiovascular mortality risk than women, the increased risk was marginal, and appropriate risk awareness is necessary for both sexes with CKD. Further research is needed to understand the impact of treatment modality and geographical distribution on sex differences in cardiovascular mortality in CKD.
慢性肾脏病（CKD）是一个重大的健康挑战，与心血管死亡率风险升高相关。历史上，一般人群中男性的心血管死亡率风险高于女性。然而，最近的研究表明，在 CKD 人群中，女性的这种风险可能与男性相似，甚至更高。为了解决 CKD 患者中性别与心血管死亡率之间关系的不确定和不一致的证据，我们对 2004 年 1 月至 2020 年 10 月期间在 PubMed/Medline、EMBASE、Scopus 和 Cochrane 数据库中发表的文章进行了系统评价和荟萃分析。共纳入了 48 项研究，这些研究报告了成年男性与女性之间的心血管死亡率，并提供了 95%置信区间（CI）或提供了足够的数据来计算风险估计（RE）。对报告和计算的估计值进行的随机效应荟萃分析表明，男性性别与 CKD 患者心血管死亡率升高相关（RE 1.13，CI 1.03-1.25）。随后的亚组分析表明，在美国进行的研究以及接受血液透析或非透析依赖 CKD 的男性中，男性的风险更高。尽管男性的心血管死亡率总体上高于女性，但风险增加幅度较小，CKD 患者的男女双方都需要适当的风险意识。需要进一步的研究来了解治疗方式和地理分布对 CKD 患者心血管死亡率性别差异的影响。
