Sex disparities in mortality and cardiovascular outcomes in chronic kidney disease

TL;DR

Women with chronic kidney disease face greater cardiovascular risks and lower life expectancy compared to men, highlighting the need for sex-specific research and treatment strategies.

Contribution

This review highlights sex disparities in cardiovascular outcomes and mortality in CKD patients and calls for sex-specific research to improve clinical outcomes.

Findings

Women on dialysis or kidney transplantation have a significantly lower life expectancy compared to men.

CKD has a more negative impact on women undergoing kidney replacement therapy compared to men.

Sex disparities in CVD outcomes among CKD patients suggest the need for tailored treatment strategies.

Abstract

Sex (biologically determined) and gender (socially constructed) modulate manifestations and prognosis of a vast number of diseases, including cardiovascular disease (CVD) and chronic kidney disease (CKD). CVD remains the leading cause of death in CKD patients. Population-based studies indicate that women present a higher prevalence of CKD and experience less CVD than men in all CKD stages, although this is not as clear in patients on dialysis or transplantation. When compared to the general population of the same sex, CKD has a more negative impact on women on kidney replacement therapy. European women on dialysis or recipients of kidney transplants have life expectancy up to 44.8 and 19.8 years lower, respectively, than their counterparts of similar age in the general population. For men, these figures stand at 37.1 and 16.5 years, representing a 21% to 20% difference, respectively. Hormonal, genetic, societal, and cultural influences may contribute to these sex-based disparities. To gain a more comprehensive understanding of these

differences and their implications for patient care, well-designed clinical trials that involve a larger representation of women and focus on sex-related variables are urgently needed. This narrative review emphasizes the importance of acknowledging the epidemiology and prognosis of sex disparities in CVD among CKD patients. Such insights can guide research into the underlying pathophysiological mechanisms, leading to optimized treatment strategies and ultimately, improved clinical outcomes.

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