The influence of sex on renal function decline in people with Type 2 diabetes

Hauteclocque, A. De; Ragot, Stéphanie; Slaoui, Yousri; Gand, Elise; Miot, A.; Sosner, P.; Halimi, Jean‐Michel; Zaoui, Philippe; Rigalleau, Vincent; Roussel, Ronan; Saulnier, Pierre Jean; Samy, S. Hadjadj

doi:10.1111/dme.12478

Cited by 70 publications

(68 citation statements)

References 25 publications

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“…Yet, despite considerable research efforts, the pathophysiological mechanisms of DN are poorly understood and effective treatments are still lacking. Over recent years, the results of basic and clinical studies have indicated a gender-related decline of renal function in type 2 diabetes mellitus (T2DM), with male gender considered a risk factor [4,5]. In line with this assumption are observations in male patients with type 1 diabetes mellitus (T1DM), in whom DN rarely appears before puberty, thereby supporting the hypothesis of a negative role of testosterone (T) [6].…”

Section: Introductionmentioning

confidence: 84%

Sex hormone levels are not associated with progression of renal disease in male patients with T2DM

Feigerlová

Saulnier

Gourdy

et al. 2017

Diabetes & Metabolism

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Section: Introductionmentioning

confidence: 84%

Sex hormone levels are not associated with progression of renal disease in male patients with T2DM

Feigerlová

Saulnier

Gourdy

et al. 2017

Diabetes & Metabolism

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“…In non-diabetic individuals with chronic kidney disease, male sex has been identified as a risk factor for rapid decline in renal function as opposed to pre-menopausal women [17]. In diabetic individuals conflicting reports exist in different populations; a recent study among Japanese subjects with type 2 diabetes identified a higher risk in women [18], whereas a report regarding European individuals indicated an increased risk for renal decline in men [19]. Thus, the influence of sex on the development of DN has yet to be established conclusively [16, 20–23].…”

Section: Introductionmentioning

confidence: 99%

Sex difference in the risk for exercise-induced albuminuria correlates with hemoglobin A1C and abnormal exercise ECG test findings

Brzezinski

Etz-Hadar

Grupper

et al. 2017

Cardiovasc Diabetol

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BackgroundAlbuminuria is an established marker for endothelial dysfunction and cardiovascular risk in diabetes and prediabetes. Exercise induced albuminuria (EiA) appears earlier and may be a more sensitive biomarker for renal endothelial damage. We sought to examine the association between EiA, parameters of the metabolic syndrome, A1C levels, exercise ECG test results and sex related differences in a large cohort of healthy, pre-diabetic and diabetic subjects.MethodsA total of 3029 participants from the Tel-Aviv Medical Center Inflammation Survey cohort (mean age 46 years, 73% men) were analyzed. Multiple physiologic and metabolic parameters including A1C were collected and albuminuria was measured in all subjects before and immediately after completing an exercise ECG test.ResultsExercise increased urinary albumin to creatinine ratio (ΔEiA) by 2.8 (0–13.6) mg/g for median (IQR) compared to rest albuminuria (p < 0.001). An increase in ΔEiA was observed with accumulating parameters of the metabolic syndrome. ΔEiA showed significant interaction with sex and A1C levels; i.e. women with A1C > 6.5% had an increased risk of higher ΔEiA (p < 0.001). Using a cutoff of ΔEiA > 13 mg/g (top quartile) we found that women with ΔEiA > 13 mg/g were at greater risk for abnormal exercise ECG findings, (OR = 2.7, p = 0.001).ConclusionExercise promotes excessive urinary albumin excretion in dysmetabolic patients. In women, a significant correlation exists between ΔEiA and A1C levels. A cutoff of ΔEiA > 13 mg/g in women may be used to identify populations at risk for abnormal exercise ECG test findings and perhaps increased cardiovascular risk. Future studies will be needed to further validate the usefulness of ΔEiA as a biomarker for cardiovascular risk in women with and without diabetes.

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“…Sex differences in CKD progression are influenced by various risk factors such as hypertension, [12,13] hyperglycemia, [14] albuminuria, [15] dyslipidemia, [16] body mass index, [17,18] lifestyle factors, [19,20] and renal structure and sex hormones. [21] Duru et al [12] demonstrated that African-American men have a higher risk of CKD progression than African-American women do because of the poorly controlled hypertension among these males.…”

Section: Introductionmentioning

confidence: 99%

“…[14] Albuminuria incidence and decreases in the eGFR might be greater among men with diabetes than among women with diabetes. [14,15,22] …”

Section: Introductionmentioning

confidence: 99%

Risk factors of gender for renal progression in patients with early chronic kidney disease

Chang

Chien²,

Lin

et al. 2016

Medicine

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Risk factors for chronic kidney disease (CKD), such as hypertension, hyperglycemia, albuminuria, renal structure, and sex hormones, have been reported to have different effects on males and females. Thus, CKD progression may differ depending on sex. In addition to CKD management, treatment at earlier stages can reduce complications and prevent disease progression as well as high medical expenses at late stages. We examined the differences in predictive risk factors for renal progression between male and female patients with early CKD.This case–cohort study recruited patients aged 18 years or older treated in the outpatient departments of 8 hospitals in Taiwan between August 2008 and September 2014. In total, 1530 patients were included in the analysis. Renal progression was defined as ≥25% decline based on baseline estimated glomerular filtration rate. To examine the predictive risk factors for renal progression, we constructed a subset multivariate logistic model with stepwise variable selection by using P < 0.10 for variable retention.The numbers of male and female patients with CKD exhibiting renal progression were 100 (11.64%) and 84 (12.52%), respectively. After adjusting for all the potential confounders, stepwise logistic regression analysis showed that main independent predictive risk factors for the male patients– (C statistic = 0.72) were proteinuria (odds ratio [OR] 2.20; 95% confidence interval [CI] 1.26–3.84), age (OR 1.04; 95% CI 1.02–1.06), anemia (OR 2.75; 95% CI 1.20–6.30), and poor control of blood pressure (OR 1.84; 95% CI 1.05–3.22). However, the main independent predictive factors for the female patients were (C statistic = 0.75) poor glycemic control (OR 2.28; 95% CI 1.22–4.25), poor blood pressure control (OR 1.93; 95% CI 1.06–3.50), and family income (OR 2.51; 95% CI 1.01–6.20).In conclusion, this study demonstrated that proteinuria was the most crucial risk factor for male patients, whereas poor glycemic control was the main risk factor for female patients. Poor blood pressure control was a shared risk factor for male and female patients.

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The influence of sex on renal function decline in people with Type 2 diabetes

Abstract: Male sex is an important independent factor associated with renal function decline in Type 2 diabetes.

Cited by 70 publications

References 25 publications

Sex hormone levels are not associated with progression of renal disease in male patients with T2DM

Sex hormone levels are not associated with progression of renal disease in male patients with T2DM

Sex difference in the risk for exercise-induced albuminuria correlates with hemoglobin A1C and abnormal exercise ECG test findings

Risk factors of gender for renal progression in patients with early chronic kidney disease

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