The rate of progression of renal disease may not be slower in women compared with men: a patient-level meta-analysis
The rate of progression of renal disease may not be slower in women compared with men: a patient-level meta-analysis
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DOI：
10.1093/ndt/gfg317
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发表时间：
2003-10-01
影响因子：
6.1
通讯作者：
Levey, AS
中科院分区：
文献类型：
--
作者：
Jafar, TH;Schmid, CH;Levey, AS
背景。一些研究表明，女性肾脏疾病的进展比男性慢。然而，与肾脏疾病进展相关的其他因素并不总是被考虑在内。因此，我们进行了这项分析，以探讨肾脏疾病进展与性别的独立关系。我们分析了纳入11项随机对照试验的非糖尿病肾病患者的汇总数据库，以评估血管紧张素转换酶抑制剂（ACEIs）减缓肾脏疾病进展的疗效。主要终点是基线血清肌酐加倍或终末期肾病（ESRD）发病的综合结局。次要终点是单纯ESRD的发病。我们进行了多变量Cox比例风险分析，在调整基线患者特征后，研究性别对这些终点的独立影响，以及从基线到随访的收缩压（SBP）和尿蛋白（UP）排泄的变化。患者总数为1860例，其中女性645例（35%），男性1215例（65%）。平均随访时间为2.2年。随机分配到ACEI的比例（51%）、平均基线血清肌酐（2.2 mg/dl）和平均年龄（52岁）在两性中相似。女性平均基线收缩压高于男性：151 mmHg vs 147 mmHg （P < 0.001）。女性的平均基线UP明显低于男性：1.3 g/天vs 2.1 g/天（P < 0.001）。共有311例（16.7%）患者达到主要终点，176例（9.5%）患者达到次要终点。女性与男性主要终点的未调整相对危险度（RR）（95%可信区间（CI））为0.98（0.77-1.24）。调整基线变量和acei与基线UP的相互作用后为1.32(1.03-1.69)，调整基线变量和随访期间收缩压和UP的变化后为1.36（1.06-1.75）。esrd的结果也有类似的结果。我们的研究结果表明，在调整了与更快的进展速度相关的其他因素后，女性肾脏疾病的进展速度可能不会比男性慢，甚至可能更快。我们需要提醒的是，我们数据库中的大多数女性都处于绝经后年龄，因此我们的研究结果可能不适用于更年轻的女性。
Background. Some studies suggest that progression of renal disease is slower in women than in men. However, other factors that are also associated with progression of renal disease have not always been taken into account. Therefore, we undertook this analysis to explore the independent association of renal disease progression with gender.Methods. We analysed a pooled database of patients with non-diabetic renal disease enrolled in 11 randomized controlled trials evaluating the efficacy of angiotensin-converting enzyme inhibitors (ACEIs) for slowing renal disease progression. The primary end point was the combined outcome of doubling of baseline serum creatinine or onset of end-stage renal disease (ESRD). The secondary end point was the onset of ESRD alone. We performed multivariable Cox proportional hazards analysis to study the independent effect of gender on these end points after adjusting for baseline patient characteristics, and changes from baseline to follow-up systolic blood pressure (SBP) and urine protein (UP) excretion.Results. The total number of patients was 1860: 645 (35%) females and 1215 (65%) males. Mean duration of follow-up was 2.2 years. The proportions randomized to ACEI (51%), mean baseline serum creatinine (2.2 mg/dl) and mean age (52 years) were similar for both genders. Mean baseline SBP was greater in women than in men: 151 vs 147 mmHg (P < 0.001). Mean baseline UP was significantly lower in women compared with men: 1.3 vs 2.1 g/day (P < 0.001). A total of 311 (16.7%) patients developed the primary end point, and 176 (9.5%) developed the secondary end point. The unadjusted relative risk (RR) with 95% confidence interval (CI) for the primary end point in women vs men was 0.98 (0.77-1.24). It became 1.32 (1.03-1.69) after adjusting for the baseline variables and interaction between ACEIs and baseline UP, and 1.36 (1.06-1.75) after adjusting for baseline variables and changes in SBP and UP during follow-up. Similar results were found for the outcome of ESRD.Conclusions. Our findings suggest that the rate of renal disease progression may not be slower, and may even be faster in women compared with men, after adjusting for other factors associated with a faster rate of progression. We caution that most women in our database were of post-menopausal age, and thus our findings may not extend to younger women.