Key result
Hypertension confers a 23% lower excess relative risk of incident chronic kidney disease or end-stage renal disease in women compared to men (RRR 0.77).
Why the study?
Hypertension is an established risk factor for chronic kidney disease and end-stage renal disease, but whether sex differences exist in this effect remains unclear.
Does hypertension increase the risk of incident chronic kidney disease or end-stage renal disease differently in women compared to men?
Systematic Review (n=2,382,712)
Does hypertension increase the risk of incident chronic kidney disease or end-stage renal disease differently in women compared to men?
Relative Risk: 0.77 (95% CI 0.63–0.95)
Hypertension confers approximately a 23% lower excess relative risk of incident chronic kidney disease or end-stage renal disease in women compared to men.
Hypertension was associated with lower excess CKD/ESRD risk in women than men; leaves open whether sex-specific BP targets warrant trials.
Background Hypertension (HTN) is an established risk factor for chronic kidney disease (CKD) and end-stage renal disease (ESRD). Whether sex differences in the effect of HTN on CKD and ESRD incidence exist remains unclear. This systematic review and meta-analysis was conducted to evaluate the relative impact of HTN on CKD and ESRD risk in women compared with men. Methods We systematically searched Embase and PubMed for cohort studies until 24 July 2020. Studies were selected if they reported a sex-specific association between systolic blood pressure (SBP) and CKD or ESRD. Random effects meta-analyses with inverse variance weighting were used to pool sex-specific relative risks (RRs) and the women-to-men ratio of RRs (the RRR) for incident CKD and ESRD. Results Data from six cohorts, including 2,382,712 individuals and 6856 incident CKD events, and 833 ESRD events, were included in the meta-analysis. The RR for incident CKD or ESRD associated with HTN (SBP ≥140 mmHg) versus ideal BP (SBP < 120 mmHg) was 1.56 (95% CI, 1.39–1.75) in women and 2.06 (95% CI, 1.64–2.60) in men. The RR for incident CKD or ESRD was 23% lower in women than in men RRR 0.77 [95% CI, 0.63–0.95] with no significant heterogeneity between studies (p-value for Q test = 0.507,I2 = 17.7%). Conclusion HTN confers about a fifth lower excess risk of incident CKD or ESRD in women than men. Sex differences in onset, duration, and severity of some risk factors, such as albuminuria, diabetes, cardiovascular disease, obesity, and socioeconomic status, may explain part of the excess risk in men. Another explanation could be that women might be under-diagnosed and less likely to initiate dialysis. Future studies are needed to demonstrate the mechanisms responsible for the observed sex difference.
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Weldegiorgis et al. (2020) conducted a systematic review in Hypertension, Chronic Kidney Disease, End-Stage Renal Disease (n=2,382,712). Hypertension (SBP ≥140 mmHg) vs. Ideal blood pressure (SBP < 120 mmHg) was evaluated on Incident chronic kidney disease or end-stage renal disease (women-to-men ratio of relative risks) (RRR 0.77, 95% CI 0.63-0.95). Hypertension confers a 23% lower excess relative risk of incident chronic kidney disease or end-stage renal disease in women compared to men (RRR 0.77).
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