Abstract
Background: Women are reported to have a lower incidence of renal replacement therapy, despite a higher prevalence of chronic kidney disease (CKD). Aim: To analyze diabetic kidney disease (DKD) progression in men and women. Methods: Prospective cohort: n = 261, 35% women, new consecutive nephrology DKD referrals. Results: Women smoked less and better complied with the dietary phosphate and sodium restrictions. Despite a less frequent nephrology referral, women had lower baseline albuminuria. Over a 30 ± 10-month follow-up, albuminuria decreased in women and the estimated glomerular filtration rate (eGFR) loss was slower than in men. However, the percentage of rapid progressors was similar in both sexes. The best multivariate model predicting rapid progression in men (area under curve (AUC) = 0.92) and women differed. Albuminuria and fractional excretion of phosphate (FEphosphate) were part of the men multivariable model, but not of women. The AUC for the prediction of rapid progression by albuminuria was higher in men than in women, and the albuminuria cut-off points also differed. In women, there was a higher percentage of rapid progressors who had baseline physiological albuminuria. Conclusions: Female DKD differs from male DKD: albuminuria was milder and better responsive to therapy, the loss of eGFR was slower and the predictors of rapid progression differed from men: albuminuria was a better predictor in men than in women. Lifestyle factors may contribute to the differences.
Highlights
There is recent interest in and controversy over the reasons behind the lower incidence of renal replacement therapy (RRT) in women, despite a higher prevalence of chronic kidney disease (CKD) [1,2,3]
We have explored gender differences in diabetic kidney disease (DKD) characteristics and progression in a contemporary cohort treated at an outpatient nephrology clinic following clinical guidelines
The distribution in the GFR G categories was similar in men and women (Figure S1A) but in men, the albuminuria A categories were skewed towards A3 as compared with women (Figure S1B)
Summary
There is recent interest in and controversy over the reasons behind the lower incidence of renal replacement therapy (RRT) in women, despite a higher prevalence of chronic kidney disease (CKD) [1,2,3]. The concern that this may represent, that is, decreased access of women to RRT, has been raised [4]. Women are reported to have a lower incidence of renal replacement therapy, despite a higher prevalence of chronic kidney disease (CKD).
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