Abstract
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.
Highlights
Chronic kidney disease (CKD) is a significant global health issue, resulting in premature death, reduced quality of life and substantial financial burden for patients [1]
Other population studies show that the hazard ratio (HR) for cardiovascular-specific and all-cause cardiovascular mortality is higher in women than men [9]
This systematic review and meta-analysis provide a comprehensive analysis of the association of sex and cardiovascular mortality among CKD patients with patient data collected from 2004 onwards
Summary
Chronic kidney disease (CKD) is a significant global health issue, resulting in premature death, reduced quality of life and substantial financial burden for patients [1]. The consensus has been that the life-long risk for cardiovascular mortality is higher in men than women within the general population [6]. A meta-analysis of renal function and the association of sex with cardiovascular mortality found that men had a higher mortality risk across all levels of renal function compared with women [7]. These findings are consistent with analyses of the European Renal Association-European Dialysis and Transplant Association Registry [8]. More recent data from 2018 suggests that women with CKD have a higher annual risk of cardiovascular hospitalisations and death than men [10]. The collective evidence regarding the role of sex on cardiovascular mortality among CKD patients is inconsistent and inconclusive
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