Differences between women and men with chronic renal disease.

ease. However, in subgroup analyses of patients in study A, there was some evidence of a lesser eVect in Background. The purpose of the present study was to compare the participation of women and men in the women than in men. Conclusions. This exploratory analysis of the MDRD protocols of the Modification of Diet in Renal Disease (MDRD) study, a multicenter prospective randomized study indicates a slower mean GFR decline in women as compared with men. The slower mean GFR decline clinical trial, and to assess gender diVerences in their renal outcomes. and suggestive evidence of a lesser beneficial eVect of the low protein diet and low blood pressure intervenMethods. Of the 840 participants in the MDRD study, 332 (39.5%) were women who were assigned randomly tions in women suggest that gender diVerences should be considered in trials of the eVects of these intervento the dietary protein and blood pressure groups and followed for a median of 2.2 years. A subgroup analysis tions on the progression of renal disease. Also, the participation of women in the MDRD study was of the MDRD study database was carried out to compare women and men participants in recruitment, excellent and equivalent to that of men. baseline characteristics, adherence to protocol requirements, safety and outcomes, and progression of renal Key words: gender; glomerular filtration rate; progresdisease and its response to dietary and blood pressure sion; renal disease interventions. Results. Adherence by women to the requirements of the protocol including diet, record keeping, oYce visits, glomerular filtration rate (GFR) measurements and Introduction urine collections was equivalent to that of men. Women had diVerent renal diagnoses, less proteinuria and The Modification of Diet in Renal Disease (MDRD) lower serum creatinine levels for given GFRs than study was a randomized, prospective, multicenter clinmen. When participants were grouped above and below ical trial [1‐3] which examined the eVects of diVerent age 52, the younger women had lower mean arterial target dietary protein intakes and blood pressure levels pressure than did the men. Older women compared on the rate of progression of chronic renal disease. with younger had higher mean arterial pressure, body In this study, 508 men and 332 women satisfied the weight and body mass index, and total low density entry criteria and were randomized. Most were follipoprotein cholesterol. These diVerences were not seen lowed for >2 years. The study required major changes between males of the same two age groups. During in diet, repeated 24-h urine collections, detailed dietary follow-up, the rate of GFR fall was slower in women, records, measurement of glomerular filtration rate especially in the younger group. However, the associ- (GFR) by [125I ]iothalamate clearance, anthropometric ation between gender and the rate of fall in GFR was measurements and complex medication regimens with attenuated and became non-significant after adjusting frequent scheduled appointments [1]. for diVerences in blood pressure, proteinuria and high Considerable evidence derived from animal studies density lipoprotein cholesterol. In analyses of the full suggests that renal disease tends to be milder and to cohort, there were no significant diVerences between progress more slowly in females. This, together with women and men in the eVects of the low protein or the much more limited evidence in human disease, has low blood pressure intervention in patients with either been reviewed recently by Silbiger and Neugarten [4]. moderate (study A) or advanced (study B) renal dis- Recent USRDS data [5] also indicate that the rate of entry into end-stage renal disease therapy is higher in