Sex disparities in mortality and cardiovascular outcomes in chronic kidney disease

Balafa, O., Fernandez-Fernandez, B., Ortiz, A., Dounousi, E., Ekart, R., Ferro, C. J., Mark, P. B. , Valdivielso, J. M., Del Vecchio, L. and Mallamaci, F. (2024) Sex disparities in mortality and cardiovascular outcomes in chronic kidney disease. Clinical Kidney Journal, 17(3), sfae044. (doi: 10.1093/ckj/sfae044)

Abstract

Sex (biologically determined) and gender (socially constructed) modulate manifestations and prognosis of a vast number of diseases, including cardiovascular disease (CVD) and chronic kidney disease (CKD). CVD remains the leading cause of death in CKD patients. Population-based studies indicate that women present a higher prevalence of CKD and experience less CVD than men in all CKD stages, although this is not as clear in patients on dialysis or transplantation. When compared to the general population of the same sex, CKD has a more negative impact on women on kidney replacement therapy. European women on dialysis or recipients of kidney transplants have life expectancy up to 44.8 and 19.8 years lower, respectively, than their counterparts of similar age in the general population. For men, these figures stand at 37.1 and 16.5 years, representing a 21% to 20% difference, respectively. Hormonal, genetic, societal, and cultural influences may contribute to these sex-based disparities. To gain a more comprehensive understanding of these differences and their implications for patient care, well-designed clinical trials that involve a larger representation of women and focus on sex-related variables are urgently needed. This narrative review emphasizes the importance of acknowledging the epidemiology and prognosis of sex disparities in CVD among CKD patients. Such insights can guide research into the underlying pathophysiological mechanisms, leading to optimized treatment strategies and ultimately, improved clinical outcomes.

• Item Type: Articles
• Additional Information: Research by AO and BFF is supported by FIS/Fondos FEDER (PI20/00744, PI22/00050, ERA-PerMed-JTC2022 (SPAREKID AC22/00027), ERAPERMED2022-248 SIGNAL (AC22/00028)), FRIAT, Comunidad de Madrid en Biomedicina P2022/BMD-7223, CIFR)A_COR-CM. Instituto de Salud Carlos III (ISCIII) RICORS program to RICORS2040 (RD21/0005/0001) funded by European Union – NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia (MRR) and SPACKDc PMP21/00109, FEDER funds; COST Action PERMEDIK CA21165, supported by COST (European Cooperation in Science and Technology). PREVENTCKD Consortium Project ID: 101101220 Programme: EU4H DG/Agency: HADEA; KitNewCare, Project ID: 101137054, Call: HORIZON-HLTH-2023-CARE-04, Programme: HORIZON, DG/Agency: HADEA.
• Keywords: Sex, gender, chronic kidney disease, cardiovascular disease, dialysis, transplantation, mortality.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Mark, Professor Patrick
• Authors: Balafa, O., Fernandez-Fernandez, B., Ortiz, A., Dounousi, E., Ekart, R., Ferro, C. J., Mark, P. B., Valdivielso, J. M., Del Vecchio, L., and Mallamaci, F.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Clinical Kidney Journal
• Publisher: Oxford University Press
• ISSN: 2048-8505
• ISSN (Online): 2048-8513
• Published Online: 21 February 2024
• Copyright Holders: Copyright © 2024 The Author(s)
• First Published: First published in Clinical Kidney Journal 17(3):sfae044
• Publisher Policy: Reproduced under a Creative Commons license