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End-stage renal disease is expected to affect more than 650,000 individuals in the United States by 2010. Contrary to earlier reports, a new study shows that renal disease progression is not slower in women than in men, and it may even be faster. Thus, doctors should not treat women with chronic renal disease less intensively than men, conclude Christopher H. Schmid, Ph.D., of New England Medical Center, and his colleagues.
In a study supported by the Agency for Healthcare Research and Quality (HS13328 and HS10064), the researchers analyzed a pooled database of patients with non-diabetic renal disease, who were enrolled in 11 randomized controlled trials evaluating the efficacy of angiotensin-converting enzyme (ACE) inhibitors for slowing renal disease progression. They defined renal disease progression as a doubling of serum creatinine (a protein end product of metabolism found in blood and muscle, which is thought to be produced in lower rates by women due to lower muscle mass and meat intake) or onset of end-stage renal disease (ESRD, kidney failure requiring dialysis).
The researchers examined the independent effect of sex on these end points, after adjusting for patient characteristics and changes from baseline to followup systolic blood pressure (SBP) and urine protein (UP) excretion, factors that also affect renal disease progression. The 645 women (most of whom were postmenopausal) and 1,215 men were followed for a mean of 2.2 years. Overall, nearly 17 percent of the patients had a doubling of baseline serum creatinine, and 9.5 percent developed ESRD. Women had a 32 to 36 percent higher risk than men of doubling baseline serum creatinine, after adjustment for other factors. Similar differences between women and men were found for development of ESRD. The researchers caution, however, that because most women in the database used for this study were of postmenopausal age, these findings may not extend to younger women.
See "The rate of progression of renal disease may not be slower in women compared with men: A patient-level meta-analysis," by Tazeen H. Jafar, M.D., M.P.H., Dr. Schmid, Paul C. Stark, Sc.D., and others, in Nephrology, Dialysis, Transplantation 18, pp. 2047-2053, 2003.
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