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Sex differences in the development of CKD complications
Gianmarco Lombardi1, Elisa De Tomi1, Chiara Lenoci1
1Section of Nephrology, Department of Medicine, Università degli Studi di Verona, Verona, Italy.
Summary
Men with chronic kidney disease (CKD) experience faster declines in hemoglobin and acidosis and a greater rise in parathyroid hormone. However, these sex-specific CKD complication patterns did not impact mortality risk.
Area of Science:
- Nephrology
- Internal Medicine
- Clinical Research
Background:
- Limited evidence exists on sex-based differences in chronic kidney disease (CKD) complications, often relying on cross-sectional data.
- This study addresses this gap by longitudinally examining CKD complication parameters and sex-specific differences.
Purpose of the Study:
- To longitudinally assess clinical and biochemical markers of CKD complications.
- To identify and compare sex-specific trajectories of CKD complications.
- To investigate the association of these complications with mortality in men and women.
Main Methods:
- Retrospective analysis of the CRIC cohort with 10-year follow-up.
- Inclusion of adults with baseline eGFR 20-70 mL/min/1.73 m².
- Longitudinal evaluation of hemoglobin, CO2, potassium, phosphate, PTH, and SBP using mixed-effects models and Cox regression for mortality, with sex-stratified analyses.
Main Results:
- Men showed higher prevalence of anemia, acidosis, hyperkalemia, and hyperparathyroidism; women had more hyperphosphatemia.
- Longitudinally, worsening eGFR correlated with declining Hb, CO2, SBP, and increasing K+, phosphate, and iPTH.
- Men exhibited steeper declines in Hb and CO2 and a more pronounced rise in iPTH compared to women. Men had higher all-cause mortality.
Conclusions:
- Significant sex-specific differences exist in the progression of CKD complications, with men experiencing more rapid changes in key parameters.
- Despite differing complication trajectories, sex did not influence mortality risk associated with these specific CKD complications.
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