Kidney function declines faster in men than women, possibly owing to unhealthier lifestyles in men and the protective effects of oestrogens or the damaging effects of testosterone.
More men than women start renal replacement therapy (RRT) not only owing to faster CKD progression in men but also because elderly women are more likely to choose conservative care.
Mortality is higher among men at all levels of predialysis CKD, whereas mortality among individuals on RRT is similar for men and women.
Also, male gender predisposes to a higher risk of cardiovascular calcification on hemodialysis , while secondary hyperparathyroidism and adynamic bone disease (both linked to higher cardiovascular risk) are also reported to be more prevalent in male patients on dialysis. However, and despite this evidence for a worse risk profile in men, both sexes die at an equal rate.
In men, urinary albumin excretion was the strongest independent predictor of renal function decline, while low waist circumference and cholesterol/HDL ratio were associated with a better renal function outcome; in women, on the other hand, low triglycerides were associated with better renal prognosis.
Endogenous estrogens have in general been considered to have anti-fibrotic & anti-apoptotic effects on the kidney On the other hand, the faster kidney function decline in men has been attributed to the specific proapoptotic and profibrotic properties of androgen.
Incident dialysis men had a 2-fold higher prevalence of cardiovascular disease and were more often smokers. , men are more likely to develop left-ventricular hypertrophy.