Relationship between sex and cardiovascular mortality in chronic kidney disease: A systematic review and meta-analysis

Abstract

Chronic kidney disease (CKD) is a significant health challenge associated with high cardiovascular mortality risk. Historically, cardiovascular mortality risk has been found to higher in men than women in the general population. However, recent research has highlighted that this risk may be similar or even higher in women than men in the CKD population. To address the inconclusive and inconsistent evidence regarding this relationship between sex and cardiovascular mortality within CKD patients, a systematic review and meta-analysis of articles published between January 2004 and October 2020 using PubMed/Medline, EMBASE, Scopus and Cochrane databases was performed. Forty-eight studies were included that reported cardiovascular mortality among adult men relative to women with 95% confidence intervals (CI) or provided sufficient data to calculate risk estimates (RE). Random effects meta-analysis of reported and calculated estimates revealed that male sex was associated with elevated cardiovascular mortality in CKD patients (RE 1.13, CI 1.03–1.25). Subsequent subgroup analyses indicated higher risk in men in studies based in the USA and in men receiving haemodialysis or with non-dialysis-dependent CKD. Though men showed overall higher cardiovascular mortality risk than women, the increased risk was marginal, and appropriate risk awareness is necessary for both sexes with CKD. Further research is needed to understand the impact of treatment modality and geographical distribution on sex differences in cardiovascular mortality in CKD.

Sex Differences in CKD-Associated Mortality From 1990 to 2019: Data From the Global Burden of Disease Study

“… 28 More recently, a meta-analysis focusing on cardiovascular-related mortality in patients with CKD found that males had an approximately 13% higher likelihood of mortality than females. 25 The geographic consistency with which we observed a lower mortality among females across a range of economically, socially, and culturally diverse countries lends weight to there being a biologic survival advantage in females. 29 However, heterogeneity in the magnitude of the sex difference, which, in 2019, ranged between a 47% lower female mortality rate in Angola to a 60% higher female mortality rate in Egypt, suggests that gendered sociocultural factors are also at play.…”

“…[21][22][23] The observation that CKD mortality is typically lower in females is consistent with previous reports. [24][25][26][27][28] For example, a 2013 meta-analysis of 46 cohorts, comprising more than 2 million patients from 5 continents, found that all-cause and cardiovascularrelated mortality were lower in females for all levels of estimated GFR and albuminuria, including those in the CKD range. 28 More recently, a meta-analysis focusing on cardiovascular-related mortality in CKD found that males had around a 13% higher risk compared to females.…”

A systematic review and meta-analysis of the association between uric acid levels and chronic kidney disease

“…“Yes” was scored as “1”, and “no” or “unclear” was scored as “0.” Scores were tallied up to calculate the final cumulative score. A study was considered high quality if the cumulative score was ≥ 4, and low quality if < 4 25 .…”

Hypertension in chronic kidney disease: What lies behind the scene

“…Clinical studies on CVD in CKD patients suggest that women carry a relatively lower risk of developing CVD and related complications compared with men ( Shajahan et al, 2021 ); however, it remains not entirely understood if these effects, as shown in hypertension, are driven by a differential influence of sex on CV regulatory control mechanisms in CKD. In relation to sex differences in vascular dysfunction, younger women (<55 years old) with CKD appear to show greater endothelium-dependent and -independent relaxation of the brachial artery than men, and that these differences disappear when women’s age exceeds 55 years ( Kruse et al, 2020 ).…”