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Sex disparities and adverse cardiovascular and kidney outcomes in patients with chronic kidney disease: results from the KNOW-CKD

Abstract

Aims

Longitudinal studies of the association between sex and adverse clinical outcomes in patients with chronic kidney disease (CKD) are scarce. We assessed whether major outcomes may differ by sex among CKD patients.

Methods

We analyzed a total of 1780 participants with non-dialysis CKD G1-5 from the KoreaN cohort study for Outcome in patients with Chronic Kidney Disease (KNOW-CKD). The primary outcome was a composite of non-fatal cardiovascular events or all-cause mortality. Secondary outcomes included fatal and non-fatal cardiovascular events, all-cause mortality, and a composite kidney outcome of ≥ 50% decline in estimated glomerular filtration rate from baseline or the onset of end-stage kidney disease.

Results

There were 1088 (61%) men and 692 (39%) women in the study cohort. The proportion of smokers was significantly higher in men (24% vs. 3%). During 8430 person-years of follow-up, 201 primary outcome events occurred: 144 (13%) in men and 57 (8%) in women, with corresponding incidence rates of 2.9 and 1.7 per 100 person-years, respectively. In multivariable Cox models, men were associated with a 1.58-fold (95% CI 1.06–2.35) higher risk of composite outcome. Propensity score matching analysis revealed similar findings (HR 1.81; 95% CI 1.14–2.91). Risk of all-cause mortality was significantly higher in men of the matched cohort. However, there was no difference in the risk of CKD progression. In the subgroup with coronary artery calcium (CAC) measurements, men had a higher likelihood of CAC progression.

Conclusions

In Korean CKD patients, men were more likely to experience adverse cardiovascular events and death than women.

Graphic abstract

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Availability of data and material

The data that support the findings of this study are available from the corresponding author (SHH) upon reasonable request.

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Funding

This work was supported by the Research Program funded by the Korea Centers for Disease Control and Prevention (2011E3300300, 2012E3301100, 2013E3301600, 2013E3301601, 2013E3301602, 2016E3300200, and 2019E320101).

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Affiliations

Authors

Contributions

C-YJ, GYH, and SHH contributed to the conception of the study. TIC, EWK, T-HY, JL, SWK, YKO, JYJ, K-HO, CA, and SHH contributed to data collection. C-YJ, GYH, HL, and SHH contributed to data analysis and interpretation. C-YJ and SHH drafted the manuscript. C-YJ, GYH, JTP, YSJ, HWK, HL, TIC, EWK, T-HY, S-WK, JL, SWK, YKO, JYJ, K-HO, CA, and SHH revised the manuscript for important intellectual content. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Seung Hyeok Han.

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Conflict of interest

The authors declare no conflicts of interest with respect to this manuscript.

Ethical approval

The study was conducted in accordance with the principles of the Declaration of Helsinki, and approved by the institutional review boards of participating institutions.

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Cite this article

Jung, CY., Heo, G.Y., Park, J.T. et al. Sex disparities and adverse cardiovascular and kidney outcomes in patients with chronic kidney disease: results from the KNOW-CKD. Clin Res Cardiol 110, 1116–1127 (2021). https://doi.org/10.1007/s00392-021-01872-5

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Keywords

  • Sex
  • Disparities
  • Cardiovascular events
  • Mortality
  • Chronic kidney disease