Kidney Risk Higher in Diabetic Women than Men

According to Margaret Yu, MD, of the University of Washington in Seattle, at baseline, diabetic women were more likely to be obese, to have high LDL cholesterol, and to have an estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m² (ORs 1.31 to 2.20).

Through five years of follow-up, they were also more likely to progress to a higher stage of chronic kidney disease and to progress to end-stage renal disease (ORs 1.34 and 1.54, respectively), although mortality rates were similar between the sexes after accounting for diabetes-related complications, Yu reported at the American Society of Nephrology meeting.

There was some evidence that women did not receive the same quality of care as men, as they were less likely to have their cholesterol checked and to get a statin.

Yu said the findings indicate that clinicians should be more vigilant about the care their female diabetic patients receive "because I think there is this overall perception that women aren't as at risk for chronic kidney disease."

She said that perception comes from the nondiabetic kidney disease literature, which shows that men have a more rapid progression to end-stage renal disease and the same type of data are not available for diabetic kidney disease.

To explore the issue, she and her colleagues examined data from 4,839 ambulatory patients with type 2 diabetes (49% female). At baseline, one-third of the patients had chronic kidney disease, defined as an eGFR of 60 mL/min/1.73 m². After multivariate adjustment, women were more likely than men to have chronic kidney disease (OR 1.31, 95% CI 1.08 to 1.58) and high LDL cholesterol (OR 1.69, 95% CI 1.39 to 2.04) and to be obese (OR 2.20, 95% CI 1.85 to 2.62).

The findings were consistent across age groups, although there were stronger associations in women 65 and older.

After five years of follow-up, women had poorer outcomes on average, even after adjustment for baseline stage of chronic kidney disease. Although there was a hint of lower mortality among female patients, the difference became nonsignificant after accounting for numerous end-organ diabetes complications (OR 0.88, 95% CI 0.71 to 1.08).

Yu said that she and her colleagues will soon be collecting 10-year follow-up data, which might be more informative than the five-year data because of the time it takes to progress to end-stage renal disease.

She also plans on conducting a survival analysis to account for the higher mortality among men.

Practice Pearls:

• Explain that five-year follow-up in a cohort of patients with type 2 diabetes found that women were more likely than men to have progression of chronic kidney disease.
• Note that type 2 diabetic women were more likely than men to have high LDL cholesterol, to be obese, to have chronic kidney disease at baseline and less likely to have had cholesterol measured and statins prescribed.
• Note that since this study was published as an abstract and presented at a conference, the data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

Yu M, et al "Gender differences in chronic kidney disease and progression in type 2 diabetes" ASN 2011; Abstract TH-PO482.