Chronic kidney disease in the elderly: the impact of patients' sex
Enfermedad renal crónica en el anciano: influencia del género
MANUEL HERASa, Manuel Herasb, PEDRO GARCIA COSMESc, Pedro García-Cosmesd, MARIA JOSE FERNANDEZ-REYESa, M. José Fernández-Reyesb, MARIA TERESA GUERREROe, M. Teresa Guerrerof, ROSA SANCHEZa, Rosa Sánchezb
a NEFROLOGIA, HOSPITAL GENERAL DE SEGOVIA, SEGOVIA, SEGOVIA, Spain,
b Servicio de Nefrología, Hospital General de Segovia, Segovia,
c NEFROLOGIA, HOSPITAL UNIVERSITARIO DE SALAMANCA, SALAMANCA, SALAMANCA, Spain,
d Servicio de Nefrología, Hospital Universitario de Salamanca, Salamanca,
e GERIATRIA, HOSPITAL GENERAL DE SEGOVIA, SEGOVIA, SEGOVIA, Spain,
f Servicio de Geriatría, Hospital General de Segovia, Segovia,
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We will also analyse the effect of this factor in patients considered as carriers of occult renal disease.</p><p class="elsevierStylePara">Between January and April 2006, we conducted a cross-sectional study in a population with a mean age of 83 years (range: 69-97 years) that was recruited when patients came in for scheduled check-ups with the Geriatric Medicine and General Nephrology Departments at the General Hospital of Segovia. In this group, 38 patients had sCr within the normal range: Group 1, sCr ≤1.1mg/dl (range 0.7-1.1): 6 males and 32 females; 42 had altered sCr. Group 2, sCr >1.1mg/dl (range 1.2-3): 19 males and 23 females.  In both groups combined, 68.8% of the patients were female; 37.3% of the total had diabetes mellitus, and 81.3% had arterial hypertension. GFR was estimated using the abbreviated MDRD method<span class="elsevierStyleSup">4</span> and the Cockcroft-Gault formula.<span class="elsevierStyleSup">5</span></p><p class="elsevierStylePara">Table 1 shows the mean GFR given by the formulae, broken down by group and sex.</p><p class="elsevierStylePara">Out of the patient total, 56 (70%) had a GFR (MDRD) <60ml/min. Of the patients with a GFR<60ml/min according to MDRD, 18 had sCr within the normal range (100% female), while 38 had a baseline sCr>1.1mg/dl (15 males [39.5%] and 23 females [60.5%], <span class="elsevierStyleItalic">P</span>=.001.</p><p class="elsevierStylePara">The 18 patients with a normal sCr and GFR by MDRD <60ml/min (occult renal disease) had a mean age of 81.33±6 years.</p><p class="elsevierStylePara">In our study, we also found that eGFR (estimated using the two methods listed here) in women with sCr within the normal range was significantly lower than in men. However, these differences are not as pronounced in the patient group with altered sCr (Group 2). Our data therefore confirm a higher prevalence rate of CKD in women if they are evaluated by eGFR; this statement is especially true for the subjects in Group 1.</p><p class="elsevierStylePara">The differences in GFR between the sexes and study groups may lie within the mathematical formulae used to estimate GFR. The mathematical formulae used in our study are based on sCr, which involves the patient’s muscle mass and nutritional state. Therefore, these significant differences in GFR between the sexes among patients with a normal sCr are more likely to show women’s smaller muscle mass rather than their true GFR. It is also important to note that the MDRD formula was designed in patients with altered renal function and not validated in a healthy population: applying the MDRD formula to estimate GFR in individuals with a normal sCr may underestimate true GFR by up to 50%.<span class="elsevierStyleSup">6</span> On the other hand, when we use the MDRD formula in patients with altered renal function, the differences between males and females are less pronounced. This means that the resulting eGFR may successfully show the presence of kidney disease rather than the patient’s nutritional state and/or muscle mass.</p><p class="elsevierStylePara">In conclusion, sex is a factor to consider when checking for chronic kidney disease in the elderly. The systematic use of formulae based on creatinine levels can lead to healthy elderly women being considered carriers of occult renal disease.</p><p class="elsevierStylePara"><a href="grande/11249_16025_26335_en_11249_t1.jpg" class="elsevierStyleCrossRefs"><img src="11249_16025_26335_en_11249_t1.jpg" alt="Mean estimated baseline glomerular filtration rates in the study group broken down by sex"></img></a></p><p class="elsevierStylePara">Table 1. Mean estimated baseline glomerular filtration rates in the study group broken down by sex</p>" "pdfFichero" => "P1-E532-S3402-A11249-EN.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11249_16025_26335_en_11249_t1.jpg" "Alto" => 270 "Ancho" => 1437 "Tamanyo" => 195991 ] ] "descripcion" => array:1 [ "en" => "Mean estimated baseline glomerular filtration rates in the study group broken down by sex" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Zhang QL, Rothenbacher D. Prevalence of chronic kidney disease in population-based studies: systematic review. 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| 2024 May | 68 | 40 | 108 |
| 2024 April | 52 | 36 | 88 |
| 2024 March | 47 | 26 | 73 |
| 2024 February | 35 | 42 | 77 |
| 2024 January | 34 | 22 | 56 |
| 2023 December | 32 | 24 | 56 |
| 2023 November | 43 | 46 | 89 |
| 2023 October | 78 | 30 | 108 |
| 2023 September | 75 | 40 | 115 |
| 2023 August | 45 | 20 | 65 |
| 2023 July | 55 | 27 | 82 |
| 2023 June | 45 | 26 | 71 |
| 2023 May | 51 | 33 | 84 |
| 2023 April | 40 | 20 | 60 |
| 2023 March | 52 | 23 | 75 |
| 2023 February | 49 | 18 | 67 |
| 2023 January | 48 | 22 | 70 |
| 2022 December | 57 | 41 | 98 |
| 2022 November | 54 | 44 | 98 |
| 2022 October | 60 | 39 | 99 |
| 2022 September | 53 | 32 | 85 |
| 2022 August | 69 | 48 | 117 |
| 2022 July | 66 | 36 | 102 |
| 2022 June | 36 | 31 | 67 |
| 2022 May | 47 | 22 | 69 |
| 2022 April | 56 | 51 | 107 |
| 2022 March | 58 | 55 | 113 |
| 2022 February | 51 | 46 | 97 |
| 2022 January | 64 | 24 | 88 |
| 2021 December | 62 | 41 | 103 |
| 2021 November | 72 | 30 | 102 |
| 2021 October | 78 | 39 | 117 |
| 2021 September | 44 | 33 | 77 |
| 2021 August | 55 | 38 | 93 |
| 2021 July | 56 | 31 | 87 |
| 2021 June | 62 | 32 | 94 |
| 2021 May | 71 | 43 | 114 |
| 2021 April | 172 | 57 | 229 |
| 2021 March | 66 | 45 | 111 |
| 2021 February | 83 | 19 | 102 |
| 2021 January | 73 | 24 | 97 |
| 2020 December | 50 | 13 | 63 |
| 2020 November | 43 | 14 | 57 |
| 2020 October | 41 | 15 | 56 |
| 2020 September | 41 | 6 | 47 |
| 2020 August | 35 | 12 | 47 |
| 2020 July | 38 | 8 | 46 |
| 2020 June | 48 | 8 | 56 |
| 2020 May | 47 | 13 | 60 |
| 2020 April | 44 | 14 | 58 |
| 2020 March | 37 | 10 | 47 |
| 2020 February | 41 | 22 | 63 |
| 2020 January | 41 | 14 | 55 |
| 2019 December | 111 | 22 | 133 |
| 2019 November | 48 | 18 | 66 |
| 2019 October | 21 | 9 | 30 |
| 2019 September | 39 | 19 | 58 |
| 2019 August | 16 | 7 | 23 |
| 2019 July | 42 | 19 | 61 |
| 2019 June | 130 | 16 | 146 |
| 2019 May | 69 | 17 | 86 |
| 2019 April | 121 | 36 | 157 |
| 2019 March | 63 | 24 | 87 |
| 2019 February | 27 | 15 | 42 |
| 2019 January | 37 | 26 | 63 |
| 2018 December | 101 | 39 | 140 |
| 2018 November | 167 | 19 | 186 |
| 2018 October | 163 | 16 | 179 |
| 2018 September | 123 | 20 | 143 |
| 2018 August | 97 | 21 | 118 |
| 2018 July | 66 | 13 | 79 |
| 2018 June | 76 | 14 | 90 |
| 2018 May | 77 | 23 | 100 |
| 2018 April | 85 | 8 | 93 |
| 2018 March | 78 | 10 | 88 |
| 2018 February | 78 | 8 | 86 |
| 2018 January | 70 | 4 | 74 |
| 2017 December | 83 | 11 | 94 |
| 2017 November | 63 | 11 | 74 |
| 2017 October | 47 | 7 | 54 |
| 2017 September | 48 | 12 | 60 |
| 2017 August | 49 | 6 | 55 |
| 2017 July | 48 | 11 | 59 |
| 2017 June | 44 | 7 | 51 |
| 2017 May | 50 | 12 | 62 |
| 2017 April | 57 | 11 | 68 |
| 2017 March | 34 | 5 | 39 |
| 2017 February | 21 | 2 | 23 |
| 2017 January | 29 | 8 | 37 |
| 2016 December | 65 | 6 | 71 |
| 2016 November | 82 | 9 | 91 |
| 2016 October | 122 | 4 | 126 |
| 2016 September | 126 | 2 | 128 |
| 2016 August | 170 | 3 | 173 |
| 2016 July | 179 | 6 | 185 |
| 2016 June | 130 | 0 | 130 |
| 2016 May | 119 | 0 | 119 |
| 2016 April | 118 | 0 | 118 |
| 2016 March | 88 | 0 | 88 |
| 2016 February | 101 | 0 | 101 |
| 2016 January | 106 | 0 | 106 |
| 2015 December | 117 | 0 | 117 |
| 2015 November | 85 | 0 | 85 |
| 2015 October | 91 | 0 | 91 |
| 2015 September | 77 | 0 | 77 |
| 2015 August | 88 | 0 | 88 |
| 2015 July | 57 | 0 | 57 |
| 2015 June | 39 | 0 | 39 |
| 2015 May | 47 | 0 | 47 |
| 2015 April | 5 | 0 | 5 |
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