The impact of gender on the risk of cardiovascular events in older adults with advanced chronic kidney disease.

Megan E Astley ,Claudia Torino,Jan-Willem Eijgenraam ,Giada Giovanna Olga Bigatti ,Alistair Woodman ,Thomas Schmiedeke ,Gaetana Porto ,Giuliana Tognarelli ,Petra Schulz ,Andrea Stucchi ,Michele Provenzano ,Cataldo Abaterusso ,Hanna Augustyniak−Bartosik ,Friedo W Dekker ,R Nigro ,Jocelyn Berdeprado ,Mary Ann Dutton ,Jacek Manitius ,Anja Schneider ,Anna-Lena Blom ,Claudio Pozzi ,Lamberto Oldrizzi ,Ferruccio Ansali ,Nadja Wuttke ,Deborah Mcglynn ,Marco Ricardi ,Alessandra Mele ,Sally Chapman ,Vianda S Stel ,Daniele Ciurlino ,Fredrik Sundelin ,Lothar Schramm ,Michael R Matthews ,Jane Turner ,Ellen Irmler ,Ivano Baragetti ,Isabel Bascaran Hernandez ,Olof Heimbürger ,Siska Boorsma ,Hirayasu Kai ,Helen Mcnally ,Anke Torp ,Sherin Manan ,Eva Platen ,Rosa Sicoli ,Stefano Maffei ,Silvio Borrelli ,Pina Acampora ,Hugh Murtagh ,Marjolijn Van Buren ,Ines Schlee ,Theresa Stephan ,Claudia Zullo ,Nina Bleakley ,Gunilla Welander ,Sadie Van Esch ,Charlotte O'toole ,Giuseppe Toscano ,Fergus Caskey ,Andrea Ranghino ,Dunja Fuchs ,T Cicchetti ,Ewout J Hoorn ,Ellen K Hoogeveen ,Marc G Vervloet ,Til Leimbach ,Marie Pippias ,Stefan Berger ,Sylvia Renker ,Silke Röser ,Roberto Scarpioni ,Domenico Russo ,Stefan Melander ,Christoph Wanner ,Katarzyna Nowańska ,Giuseppe Conte ,Carla J Barrett ,Udo Bahner ,Cynthia Janmaat ,Stephanie Palm ,Giordano Fumagalli ,Philip A Kalra ,Andreas Jönsson ,Liffert Vogt ,Torsten Stövesand ,Maria Laudato ,Henk Boom ,Christian Marx ,Daria Motta ,Giovanni Gambaro ,Claudia D’alessandro ,Fergus Caskey ,Beate Iwig ,Francesco Cappellaio ,Maria Stendahl ,Charles Beerenhout ,Thomas Weinreich ,Alessandro Naticchia ,Rincy Sajith ,Nikolaus Frischmuth ,Chiara Somma ,Francesco Pizzarelli ,Geena Roy ,Camille Harron ,Margaret Carmody ,Stefania Maxia ,Sabine Cäsar ,Ferruccio Conte ,Katrin Neumeier ,Giovambattista Capasso ,Butti Alessandra ,Francesca Cianciotta ,Martina Ferraresi ,Walter De Simone ,Justyna Mazur ,Irene Capizzi ,Maria Svensson ,Gaetano Greco ,Sylvia Schättel ,Pauline Voskamp ,Houda Masri-Senghor ,Colin C Geddes ,Nicholas Chesnaye ,Katja Blouin ,M H M Raasveld ,Suresh Mathavakkannan ,Kirsten Anding-Rost ,Holger Naujoks ,Christina Summersgill ,Paul Roderick ,Adamasco Cupisti ,Joanna Pondel ,Fredrik Uhlin ,Carlo A J M Gaillard ,Pietro Dattolo ,Alex Còsaro ,Enrico Favaro ,Martin Joinson ,Francesca Giacchino ,Joachim Beige ,Cornelis A Verburgh ,Susanne Schwedler ,Magdalena Durlik ,Tora Almquist ,Santee Navjee ,Ulrika Jensen ,Antonio Bellasi ,Daniela Bergamo ,Peter J Blankestijn ,Giorgia Apollonia Caloro ,Stefano Mangano ,Kirsteen Jones ,Jochen Röthele ,Pietro Cirillo ,Pavlos Kashioulis ,Kitty J Jager ,Bastiaan Van Dam ,Giancarlo Marinangeli ,Kamila Jędrzejak ,Federica Neve Vigotti ,C E H Siegert ,Adelia Sagliocca ,Pawlos Ichtiaris ,Boris Perras ,María Di Bari ,Sharon A Brown ,Paola Murrone ,Anna Szymczak ,Anita Schrander ,Esther De Rooij ,Angelo Pignataro ,Paul Leurs ,Nicola Palmieri ,Sarah Crosbie ,Hayley King ,R Boero ,Carin Wallquist ,Claudia Emde ,Johannes M M Boots ,N O Morgan ,Hans Schmidt-Gürtler ,Sylke Delrieux ,Christof Blaser ,Szyszkowska Dorota ,Giuseppe Bonforte ,Rosella Malandra ,Maria Weetman ,Phil Mason ,Deborah Glowski ,Emöke Dimény ,Antonello Pani ,Sabine Aign ,Aris Tsalouichos ,Björn Rogland ,Gianfranca Cabiddu ,Marie Evans ,Joanne Wilcox ,Alberto Ferraro ,Christiane Drechsler ,Sandra Biribauer ,Ilona Miśkowiec-Wiśniewska ,Goffredo Del Rosso ,Zeynep Gökçe Gayretli Aydın ,Moreno Malaguti ,Silvana Savoldi ,Teresa Nieszporek ,Joyce Banda ,Detlef H Krieter ,Valentina Palazzo ,Anna Mckeever ,Monika Hopf ,Werner Seeger ,Hugh Rayner ,Manuela Magnano ,Barbara A Mclaren ,Loreto Gesualdo ,Constantijn Konings ,Hendrik Schlee ,Paul Cockwell ,Lily Wilkinson ,Jonathan W C Wong ,Maria Luisa Sirico ,Merel Van Diepen ,Stefan Heidenreich ,Petra Kirste ,Asad Ullah ,Biagio Raffaele Di Iorio ,Dympna Sands ,Giorgina Barbara Piccoli ,Ewelina Olczyk ,Antonella De Blasio ,Denes Vargas ,Łukasz Nowak ,Aleksandra Musiała ,Jeroen P Kooman ,Gillian Hirst ,Maciej Szymczak ,Tiziana Rappa ,Zbigniew Heleniak ,Knut-Christian Gröntoft ,Lesley Haydock ,Joris I Rotmans ,Sheila Tickle ,Luigi Biancone ,Silvio Bertoli ,Ying Kuan

doi:10.1093/ckj/sfad088

Abstract

Patients with chronic kidney disease (CKD) are at a higher risk of major adverse cardiovascular events (MACE) compared with the general population, but gender differences in this risk, especially in older adults, are not fully known. We aim to identify gender differences in the risk of MACE in older European CKD patients, and explore factors that may explain these differences. The European Quality study (EQUAL) is a prospective study on stage 4-5 CKD patients, ≥65 years old, not on dialysis, from Germany, Italy, the Netherlands, Poland, Sweden and the UK. Cox regression and cumulative incidence competing risk curves were used to identify gender differences in MACE risks. Mediation analysis was used to identify variables which may explain risk differences between men and women. A total of 417 men out of 1134 (37%) and 185 women out of 602 women (31%) experienced at least one MACE, over a follow-up period of 5 years. Women had an 18% lower risk of first MACE compared with men (hazard ratio 0.82; 95% confidence interval 0.69-0.97; P=.02), which was attenuated after adjusting for pre-existing cardiometabolic comorbidities and cardiovascular risk factors. There were no significant gender differences in the risk of recurrent MACE or fatal MACE. The risk difference in MACE by gender was larger in patients aged 65-75 years, compared with patients over 75 years. In a cohort of older adults with advanced CKD, women had lower risks of MACE. These risk differences were partially explained by pre-existing cardiometabolic comorbidities and cardiovascular risk factors.

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