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

Secular trends of epidemiologic patterns of chronic kidney disease over three decades: an updated analysis of the Global Burden of Disease Study 2019

“…Chronic kidney disease (CKD) refers to chronic renal dysfunction caused by various factors for more than 3 months 1 2. According to relevant statistics, there were an estimated 697.5 million cases of CKD worldwide in 2017 1.…”

Sex and gender differences in the management of chronic kidney disease and hypertension

“…In contrast to decreasing trends observed over time for other sequelae of hypertension (such as stroke and ischaemic heart disease), CKD is a growing problem: age-standardised mortality rates in CKD remain stubbornly high [ 2 ]; and by 2040, CKD is projected to be the fifth leading cause of death worldwide [ 3 ]. Sex and gender have key impacts on many aspects of CKD - including prevalence and patterns of disease, treatment decisions and clinical outcomes (Fig.…”

“…Sex and gender have key impacts on many aspects of CKD - including prevalence and patterns of disease, treatment decisions and clinical outcomes (Fig. 1 ) [ 2 , 4 , 5 ]. Though often incorrectly used interchangeably, sex and gender must be understood as different concepts.…”

“…Accepting limitations relating to sampling bias and the markers used to estimate kidney function, CKD is reported to be more common in women, yet is thought to progress more slowly compared with men [ 5 , 6 ]. Perhaps as a consequence, both kidney replacement therapy [ 7 ] and age-standardised CKD-related mortality are markedly higher in men [ 2 ]: the Global Burden of Disease Study (spanning over 20 years) quantified this increased CKD mortality risk at around 30% [ 2 ]. Sex differences were broadly consistent across 50 countries, which may suggest biological sex is a greater contributor to CKD-related mortality than socio-cultural gender-related factors.…”

“…Hormones are likely to influence sex differences in CKD–whether due to beneficial effects of oestrogen or deleterious effects of testosterone [ 8 ]. Though hormones may be particularly influential during reproductive years, the Global Burden of Disease Study found that sex differences in CKD-related mortality were remarkably consistent from ages 20 to 90 years [ 2 ]. Regardless, sex certainly complicates the prescription of disease-modifying treatment for CKD and hypertension, such as the use of renin-angiotensin system (RAS) inhibitors in women of child-bearing potential.…”