Nephrol Dial Transplant. 2025 Oct 16:gfaf217. doi: 10.1093/ndt/gfaf217. Online ahead of print.
ABSTRACT
BACKGROUND AND HYPOTHESIS: Women exhibit a lower cardiovascular risk and longer life expectancy compared to men in the general population. However, this advantage is diminished in dialysis and transplant patients, suggesting greater excess risk, i.e. risk above the general population, in women with kidney failure. Yet, data on excess risk in CKD populations, using those without CKD as the reference, are lacking.
METHODS: In this retrospective cohort study, we analyzed de-identified, patient-level data from electronic medical records within the TriNetX database. Adults aged 18-90 years with an eGFR ≥ 15mL/min/1.73m2 without maintenance dialysis or kidney transplantation were included. Primary outcomes were all-cause mortality and cardiovascular composite outcome. Analyses were adjusted for age, sociodemographic factors, cardiovascular risk factors, laboratory measurements, medications, and history of CVD, using multivariable Cox proportional hazards models.
RESULTS: Of 328,431 eligible individuals, 43,830 were women with CKD, 45,173 men with CKD, 127,383 women without CKD and 112,045 men without CKD. In individuals without CKD, women displayed a reduced risk of all-cause mortality (HR 0.53; 95% CI 0.49-0.58) and cardiovascular events (HR 0.70; 95% CI 0.68-0.71) compared to men. However, this risk reduction in women compared to men was significantly attenuated in individuals with CKD both for all-cause mortality (HR 0.73; 95% CI 0.69-0.77) and for cardiovascular events (HR 0.80; 95% 0.78-0.82). Consequently, CKD conferred significantly greater excess risk of mortality and cardiovascular events in women compared to men, consistent across different levels of kidney function, age, and systolic blood pressure.
CONCLUSIONS: The cardiovascular and survival advantage observed in women compared to men in the general population is significantly reduced in individuals with CKD, confining an increased excess risk in women with CKD.
PMID:41100161 | DOI:10.1093/ndt/gfaf217
