de Sequera Patricia, Arias Javier, Quiroga Borja, Benavent María, Procaccini Fabio, Romero Iago, López Guillermo, Diez Javier, Ortiz Alberto
Department of Nephrology, University Hospital Infanta Leonor, Madrid, Spain; Department of Medicine, Universidad Complutense de Madrid, Madrid, Spain; RICORS2040, Madrid, Spain.
Medsavana SL, Madrid, Spain.
Nefrologia (Engl Ed). 2025 Jan;45(1):87-93. doi: 10.1016/j.nefroe.2025.01.002.
Chronic kidney disease (CKD) is associated with high cardiovascular disease (CVD) risk, and requires specific interventions to decreases CVD risk. The guidelines indicate that systematic global CVD risk assessment is recommended in individuals with any major vascular risk factor. The European Society Cardiology (ESC) guidelines, he European Renal Association (ERA) Council and the Spanish Society of Nephrology (S.E.N.) in collaboration with 15 Scientific Societies recommend assessing albuminuria in all these populations. We have evaluated current clinical practice regarding the assessment of CVD risk factors (blood pressure, albuminuria, serum cholesterol, glycemia and creatinine) in different adult health user populations, analyzing the results separately for men and women, given recent evidence on gender differences in the recognition, monitoring, and management of CKD.
Observational, retrospective, non-interventional single center study performed in a hospital using Electronic Health Record (EHR) data.
Among 707,493 healthcare users, 612,619 were adults, and of these 332,943 (54.3%) females; 73,632 (12.0%) had DM and 121,445 (19.8%) hypertension. Mean (SD) age was 68.91±21.4 years; 261,694 (36.9%) were older than 50 years. Only 8522 (1.39%) had undergone albuminuria testing as compared with 264,684 (43.21%) tested for serum creatinine, 140,492 (22.93%) for serum cholesterol, 263,381 (42.99%) for serum glucose, and 226,448 (36.96%) for blood pressure. Albuminuria was the only cardiovascular risk factor assessed more frequently in men than in women. Albuminuria, as other CVD risk factors, was more frequently assessed in patients with DM (6.71% of patients) or hypertension (4.81%), but albuminuria assessment remained suboptimal compared with 58-87% for other cardiovascular risk factors. For adults with diabetes or hypertension, albuminuria was assessed more frequently in men than in women. Albuminuria assessment in those older than 50 years was also suboptimal at 2.24%, as compared with 31-47% for other CVD risk factors. Albuminuria and EGFR are needed to screen for CKD, meaning that a urine test for albumin and creatinine and a serum test for creatinine are needed. To these, we may add assessment of blood pressure, serum cholesterol (for familial hypercholesterolemia) and serum glucose for Diabetes. Albuminuria was the only cardiovascular risk factor that was assessed more frequently in men (up to nearly 60% more frequently), indicating that screening for CKD and CVD risk in women is suboptimal. This result is surprisingly consistent across time and in all age groups. This is the first time that gender disparities in the assessment of albuminuria have been revealed.
Albuminuria is assessed infrequently, even in patients with a high cardiovascular risk, especially in women.
慢性肾脏病（CKD）与心血管疾病（CVD）高风险相关，需要采取特定干预措施以降低CVD风险。指南指出，对于有任何主要血管危险因素的个体，建议进行系统的全球CVD风险评估。欧洲心脏病学会（ESC）指南、欧洲肾脏协会（ERA）理事会以及西班牙肾脏病学会（S.E.N.）与15个科学学会合作，建议在所有这些人群中评估蛋白尿。鉴于最近有关CKD识别、监测和管理中性别差异的证据，我们评估了不同成年健康用户群体中CVD危险因素（血压、蛋白尿、血清胆固醇、血糖和肌酐）评估的当前临床实践，并分别分析了男性和女性的结果。
在一家医院利用电子健康记录（EHR）数据进行的观察性、回顾性、非干预性单中心研究。
在707493名医疗用户中，612619名是成年人，其中332943名（54.3%）为女性；73632名（12.0%）患有糖尿病，121445名（19.8%）患有高血压。平均（标准差）年龄为68.91±21.4岁；261694名（36.9%）年龄超过50岁。与264684名（43.21%）进行血清肌酐检测、140492名（22.93%）进行血清胆固醇检测、263381名（42.99%）进行血糖检测以及226448名（36.96%）进行血压检测相比，只有8522名（1.39%）进行了蛋白尿检测。蛋白尿是唯一一项在男性中评估频率高于女性的心血管危险因素。与其他CVD危险因素58 - 87%的评估频率相比，蛋白尿以及其他CVD危险因素在糖尿病患者（6.71%的患者）或高血压患者（4.81%）中评估频率更高，但蛋白尿评估仍不理想。对于患有糖尿病或高血压的成年人，男性中蛋白尿评估频率高于女性。50岁以上人群中蛋白尿评估同样不理想，为2.24%，而其他CVD危险因素的评估频率为31 - 47%。筛查CKD需要蛋白尿和估算肾小球滤过率（EGFR），这意味着需要进行尿白蛋白和肌酐检测以及血清肌酐检测。除此之外，我们还可以增加血压、血清胆固醇（用于家族性高胆固醇血症）和血糖检测以筛查糖尿病。蛋白尿是唯一一项在男性中评估频率更高（高达近60%）的心血管危险因素，这表明女性中CKD和CVD风险筛查不理想。这一结果在不同时间和所有年龄组中惊人地一致。这是首次揭示蛋白尿评估中的性别差异。
即使在心血管风险高的患者中，蛋白尿评估也不常见，尤其是在女性中。
