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The impact of gender on the risk of cardiovascular events in older adults with advanced chronic kidney disease

2023; Oxford University Press; Volume: 16; Issue: 12 Linguagem: Inglês

10.1093/ckj/sfad088

2048-8513

Megan E Astley, Fergus Caskey, Marie Evans, Claudia Torino, Maciej Szymczak, Christiane Drechsler, Maria Pippias, Esther de Rooij, Gaetana Porto, Vianda S Stel, Friedo W. Dekker, Christoph Wanner, Kitty J. Jager, Nicholas C. Chesnaye, Andreas Schneider, Anke Torp, Beate Iwig, Boris Perras, Christian Marx, Christiane Drechsler, Christof Blaser, Christoph Wanner, Claudia Emde, Detlef H. Krieter, Dunja Fuchs, Ellen Irmler, Eva Platen, Hans Schmidt-Gürtler, Hendrik Schlee, Holger Naujoks, Ines Schlee, Sabine Cäsar, Joachim Beige, Jochen Röthele, Justyna Mazur, Kai Hahn, Katja Blouin, Katrin Neumeier, Kirsten Anding‐Rost, Lothar Schramm, Monika Hopf, Nadja Wuttke, Nikolaus Frischmuth, Pawlos Ichtiaris, Petra Kirste, Petra Schulz, Sabine Aign, Sandra Biribauer, Sherin Manan, Silke Röser, Stefan Heidenreich, Stephanie Palm, Susanne Schwedler, Sylke Delrieux, Sylvia Renker, Sylvia Schättel, Theresa Stephan, Thomas Schmiedeke, Thomas Weinreich, Til Leimbach, Torsten Stövesand, Udo Bahner, Werner Seeger, Adamasco Cupisti, Adelia Sagliocca, Alberto Ferraro, Alessandra Mele, Alessandro Naticchia, Alex Còsaro, Andrea Ranghino, Andrea Stucchi, Angelo Pignataro, Antonella De Blasio, Antonello Pani, Aris Tsalouichos, Antonio Bellasi, Biagio Di Iorio, Butti Alessandra, Cataldo Abaterusso, Chiara Somma, Claudia D’Alessandro, Claudia Torino, Claudia Zullo, Claudio Pozzi, Daniela Bergamo, Daniele Ciurlino, Daria Motta, Domenico Russo, Enrico Favaro, Federica Neve Vigotti, Ferruccio Ansali, Ferruccio Conte, Francesca Cianciotta, Francesca Giacchino, Francesco Cappellaio, Francesco Pizzarelli, Gaetano Greco, Gaetana Porto, Giada Bigatti, Giancarlo Marinangeli, Gianfranca Cabiddu, Giordano Fumagalli, Giorgia Apollonia Caloro, Giorgina Barbara Piccoli, Giovambattista Capasso, Giovanni Gambaro, Giuliana Tognarelli, Giuseppe Bonforte, Giuseppe Conte, Giuseppe Toscano, Goffredo Del Rosso, Irene Capizzi, Ivano Baragetti, Lamberto Oldrizzi, Loreto Gesualdo, Luigi Biancone, Manuela Magnano, Marco Ricardi, María Di Bari, Maria Laudato, Maria Luisa Sirico, Martina Ferraresi, Michele Provenzano, Moreno Malaguti, Nicola Palmieri, Paola Murrone, Pietro Cirillo, Pietro Dattolo, Pina Acampora, Rita Nigro, R Boero, Roberto Scarpioni, Rosa Sicoli, Rosella Malandra, Silvana Savoldi, Silvio Bertoli, Silvio Borrelli, Stefania Maxia, Stefano Maffei, Stefano Mangano, Teresa Cicchetti, Tiziana Rappa, Valentina Palazzo, Walter De Simone, Anita Schrander, Bastiaan van Dam, C. E. H. Siegert, Sandrine Gaillard, Charles Beerenhout, Cornelis A. Verburgh, Cynthia Janmaat, Ellen K. Hoogeveen, Ewout J. Hoorn, Friedo W. Dekker, Johannes M. M. Boots, Henk Boom, Jan‐Willem Eijgenraam, Jeroen P. Kooman, Jan Rotmans, Kitty J. Jager, Liffert Vogt, Maarten Raasveld, Marc G. Vervloet, Marjolijn van Buren, Merel van Diepen, Nicholas C. Chesnaye, Paul Leurs, Pauline Voskamp, Peter J. Blankestijn, Sadie van Esch, Siska Boorsma, Stefan Berger, Constantijn Konings, Zeynep Gökçe Gayretli Aydın, Aleksandra Musiała, Maciej Szymczak, Ewelina Olczyk, Hanna Augustyniak‐Bartosik, Ilona Miśkowiec‐Wiśniewska, Jacek Manitius, Joanna Pondel, Kamila Jędrzejak, Katarzyna Nowańska, Łukasz R. Nowak, Maciej Szymczak, Magdalena Durlik, Szyszkowska Dorota, Teresa Nieszporek, Zbigniew Heleniak, Andreas Jönsson, Anna‐Lena Blom, Björn Rogland, Carin Wallquist, Denes Vargas, Emöke Dimény, Fredrik Sundelin, Fredrik Uhlin, Gunilla Welander, Isabel Bascaran Hernandez, Knut‐Christian Gröntoft, Maria Stendahl, Maria Svensson, Marie Evans, Olof Heimbürger, Pavlos Kashioulis, Stefan Melander, Tora Almquist, Ulrika Jensen, Alistair Woodman, Anna McKeever, Asad Ullah, Barbara A. McLaren, Camille Harron, Carla Barrett, Charlotte O’Toole, Christina Summersgill, Colin Geddes, Deborah Glowski, Deborah McGlynn, Dympna Sands, Fergus Caskey, Geena Roy, Gillian L. Hirst, H.D. King, Helen McNally, Houda Masri‐Senghor, Hugh Murtagh, Hugh C. Rayner, Jane Turner, Joanne Wilcox, Jocelyn Berdeprado, Jonathan W.C. Wong, Joyce Banda, Kirsteen Jones, Lesley Haydock, Lily Wilkinson, Margaret Carmody, Maria Weetman, Martin Joinson, Mary Ann Dutton, Michael R. Matthews, N. O. Morgan, Nina Bleakley, Paul Cockwell, Paul Roderick, Phil Mason, Philip A. Kalra, Rincy Sajith, Sally Chapman, Santee Navjee, Sarah Crosbie, Sharon A. Brown, Sheila Tickle, Suresh Mathavakkannan, Ying Kuan,

Dialysis and Renal Disease Management

Patients with chronic kidney disease (CKD) are at a higher risk of major adverse cardiovascular events (MACE) compared with the general population, but gender differences in this risk, especially in older adults, are not fully known. We aim to identify gender differences in the risk of MACE in older European CKD patients, and explore factors that may explain these differences.The European Quality study (EQUAL) is a prospective study on stage 4-5 CKD patients, ≥65 years old, not on dialysis, from Germany, Italy, the Netherlands, Poland, Sweden and the UK. Cox regression and cumulative incidence competing risk curves were used to identify gender differences in MACE risks. Mediation analysis was used to identify variables which may explain risk differences between men and women.A total of 417 men out of 1134 (37%) and 185 women out of 602 women (31%) experienced at least one MACE, over a follow-up period of 5 years. Women had an 18% lower risk of first MACE compared with men (hazard ratio 0.82; 95% confidence interval 0.69-0.97; P = .02), which was attenuated after adjusting for pre-existing cardiometabolic comorbidities and cardiovascular risk factors. There were no significant gender differences in the risk of recurrent MACE or fatal MACE. The risk difference in MACE by gender was larger in patients aged 65-75 years, compared with patients over 75 years.In a cohort of older adults with advanced CKD, women had lower risks of MACE. These risk differences were partially explained by pre-existing cardiometabolic comorbidities and cardiovascular risk factors.