Diabetes Mellitus As A Risk Factor For Incident Chronic Kidney Disease And End-stage Renal Disease In Women Compared With Men: A Systematic Review And Meta-analysis

PurposeDiabetes mellitus(DM)is a strong risk factor for chronic kidney disease(CKD)and end-stage renal disease(ESRD).Whether sex differences in CKD and ESRD incidence exist among diabetic patients remains unclear.This systematic review and meta-analysis was conducted to evaluate the relative effect of diabetes on CKD and ESRD risk in women compared with men.MethodsEmbase,PubMed and the Cochrane Library were systematically searched for both cohort and case-control studies until October 2015.Studies were selected if they reported a sex-specific relationship between DM and CKD or ESRD.We generated pooled estimates across studies using random-effects meta-analysis after log transformation with inverse variance weighting.The Cochran Q tests and I2 statistics were used to assess the heterogeneity between studies.Subgroup analyses and meta-regression were employed to explore potential sources of heterogeneity.Publication bias was assessed by using Egger's regression test,funnel plot and "trim-and-fill"analysis.ResultsTen studies with data from more than five million participants were included.The pooled adjusted risk ratio of CKD associated with DM was 3.34(95%Cl 2.27,4.93)in women and 2.84(95%CI 1.73,4.68)in men.The data showed no difference in diabetes-related CKD risk between the sexes(pooled adjusted women-to-men relative risk ratio was 1.14[95%CI 0.97,1.34];p<0.001,I2=85.3%).Meta-regression indicated that the pooled RRR for CKD was not affected by the mean age of the participants(p =0.220),by baseline prevalence of diabetes(p =0.861),nor by the baseline year of each study(p=0.333).The Egger's regression test and "trim-and-fill" analysis provided no evidence of substantial publication bias.For end-stage renal disease,the pooled adjusted women-to men relative risk ratio was 1.38(95%CI 1.22,1.55;p =0.114,I2 =38.1%).The Egger's regression test and funnel plot provided no evidence of substantial publication bias.ConclusionsThe study found no evidence of a sex difference in the association between DM and CKD.However,the excess risk for ESRD was higher in women with diabetes than in men with the same condition,from which we assume that the female gender could accelerate the disease progression.Further studies are needed to support this notion and elucidate the underlying mechanisms.