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Sex Differences in 6-Year Change in eGFR and ACR in a Multiethnic Population: The HELIUS Study
Taryn G Vosters1, Muhulo M Mungamba1, Sarah A van Eeghen2,3,4
1Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Rationale & Objective:
Data on sex differences in kidney function within multiethnic populations are scarce despite the large differences in chronic kidney disease (CKD) in women and men. We investigated the 6-year changes in the estimated glomerular filtration rate (eGFR) and albumin-creatinine ratio (ACR) in women and men, both overall and across ethnic groups, and determined whether sex differences in associations with outcomes are mediated by known CKD risk factors.
Study Design:
General population based longitudinal study.
Setting & Participants:
We used prospective data of 5,713 women and 4,407 men from 6 ethnic backgrounds from the Healthy Life in an Urban Setting (HELIUS) study (Amsterdam, the Netherlands).
Exposures:
Municipality registered sex.
Outcomes:
Change in eGFR (mL/min/1.73 m2) and ACR (mg/mmol) between baseline (2011-2015) and follow-up (2019-2021) data collection. CKD incidence and progression were analyzed as secondary outcomes.
Analytical Approach:
Linear regression analyses adjusted for baseline kidney function estimates, follow-up duration, age, education, and ethnicity in the total population and stratified by ethnicity. Mediation by hypertension, diabetes, cardiovascular disease, obesity, physical activity, alcohol consumption, and smoking was tested.
Results:
Although no significant sex differences were found in the overall population, Dutch and African Surinamese women had a greater decrease in eGFR (β:1.2 (0.5-1.8)) than men, whereas South-Asian Surinamese and Moroccan men had a greater decrease in eGFR (β:-1.0 (-2.0 to 0.0)) than women. ACR was higher in men, although this difference did not reach statistical significance (β:0.6 (0.3-1.1), P = 0.09). Sex differences in CKD incidence across certain ethnic groups aligned with the observed eGFR differences, whereas CKD progression was higher in men overall. Little evidence of mediation by CKD risk factors of the sex differences was observed.
Limitations:
Single eGFR and ACR measurements, self-reported mediator variables, and limited generalizability.
Conclusions:
Disparate sex differences in the changes in eGFR, CKD incidence, and progression were observed, specifically in some ethnic groups. These differences were not mediated by differences in traditional risk factors and health-related behaviors.
