Differential cardiovascular risk profiles by sex among adults with CKD: a NHANES-based analysis

IntroductionChronic kidney disease (CKD) and cardiovascular disease are closely interconnected, with cardiovascular disease the leading cause of death for those with CKD. This increased risk for those with CKD is partly attributed to shared risk factors between the conditions. These risk factors dif...

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Main Authors: Hannah T. Belikoff, Ramya Walsan, Cara M. Hildreth, Jacqueline K. Phillips
Format: Article
Language:English
Published: Frontiers Media S.A. 2025-05-01
Series:Frontiers in Cardiovascular Medicine
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Online Access:https://www.frontiersin.org/articles/10.3389/fcvm.2025.1544590/full
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author Hannah T. Belikoff
Ramya Walsan
Cara M. Hildreth
Jacqueline K. Phillips
author_facet Hannah T. Belikoff
Ramya Walsan
Cara M. Hildreth
Jacqueline K. Phillips
author_sort Hannah T. Belikoff
collection DOAJ
description IntroductionChronic kidney disease (CKD) and cardiovascular disease are closely interconnected, with cardiovascular disease the leading cause of death for those with CKD. This increased risk for those with CKD is partly attributed to shared risk factors between the conditions. These risk factors differ in presentation between females and males; however, further research is needed to better understand how sex influences cardiovascular risk factors among individuals with CKD.MethodsData from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2018 was utilised. CKD was classified as an albumin-to-creatinine ratio ≥30 mg/g or an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2. Participants were categorized into GFR categories based on their eGFR results for further analysis. Two-way ANOVAs compared means across groups, and a Tukey's post hoc test was performed to assess the statistical significance between group means. Multivariable logistic regression was used to determine the association between cardiovascular risk factors and sex among individuals with and without CKD.ResultsA total of 30,804 participants aged 20 years and older were included, in which 5,528 were classified as having CKD. Our analyses of participants by sex and GFR categories revealed that for both females and males, as renal function declined, systolic blood pressure increased while haemoglobin and haematocrit levels decreased. Multivariate logistic regression revealed that females with CKD demonstrated reduced odds for diabetes (OR: 0.53, CI: 0.42–0.66), hypertension (OR: 0.80, CI: 0.66–0.97), low haematocrit (OR: 0.47, CI: 0.40–0.56), and elevated triglycerides (OR: 0.75, CI: 0.63–0.88), yet exhibited increased odds of a high waist circumference (OR: 1.69, CI: 1.40–2.04) and low high-density lipoprotein cholesterol (HDL-C) (OR: 1.18, CI: 1.00–1.39), compared to males with CKD.ConclusionSex-based differences in cardiovascular risk factors among individuals with CKD reveal that females have lower odds of diabetes, hypertension, low haematocrit and elevated triglycerides, but higher odds of increased waist circumference and low HDL-C compared to males. These findings highlight the need to incorporate sex-specific perspectives into CKD research and management to improve personalized care.
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spelling doaj-art-a4ae5f6d3635402b8de00ae4ff0b2c8a2025-08-20T02:56:44ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2025-05-011210.3389/fcvm.2025.15445901544590Differential cardiovascular risk profiles by sex among adults with CKD: a NHANES-based analysisHannah T. Belikoff0Ramya Walsan1Cara M. Hildreth2Jacqueline K. Phillips3Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, AustraliaAustralian Institute of Health Innovation, Macquarie University, Sydney, NSW, AustraliaFaculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, AustraliaFaculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, AustraliaIntroductionChronic kidney disease (CKD) and cardiovascular disease are closely interconnected, with cardiovascular disease the leading cause of death for those with CKD. This increased risk for those with CKD is partly attributed to shared risk factors between the conditions. These risk factors differ in presentation between females and males; however, further research is needed to better understand how sex influences cardiovascular risk factors among individuals with CKD.MethodsData from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2018 was utilised. CKD was classified as an albumin-to-creatinine ratio ≥30 mg/g or an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2. Participants were categorized into GFR categories based on their eGFR results for further analysis. Two-way ANOVAs compared means across groups, and a Tukey's post hoc test was performed to assess the statistical significance between group means. Multivariable logistic regression was used to determine the association between cardiovascular risk factors and sex among individuals with and without CKD.ResultsA total of 30,804 participants aged 20 years and older were included, in which 5,528 were classified as having CKD. Our analyses of participants by sex and GFR categories revealed that for both females and males, as renal function declined, systolic blood pressure increased while haemoglobin and haematocrit levels decreased. Multivariate logistic regression revealed that females with CKD demonstrated reduced odds for diabetes (OR: 0.53, CI: 0.42–0.66), hypertension (OR: 0.80, CI: 0.66–0.97), low haematocrit (OR: 0.47, CI: 0.40–0.56), and elevated triglycerides (OR: 0.75, CI: 0.63–0.88), yet exhibited increased odds of a high waist circumference (OR: 1.69, CI: 1.40–2.04) and low high-density lipoprotein cholesterol (HDL-C) (OR: 1.18, CI: 1.00–1.39), compared to males with CKD.ConclusionSex-based differences in cardiovascular risk factors among individuals with CKD reveal that females have lower odds of diabetes, hypertension, low haematocrit and elevated triglycerides, but higher odds of increased waist circumference and low HDL-C compared to males. These findings highlight the need to incorporate sex-specific perspectives into CKD research and management to improve personalized care.https://www.frontiersin.org/articles/10.3389/fcvm.2025.1544590/fullchronic kidney diseasecardiovascular risk factorssex-differencesNHANEShypertensionanaemia
spellingShingle Hannah T. Belikoff
Ramya Walsan
Cara M. Hildreth
Jacqueline K. Phillips
Differential cardiovascular risk profiles by sex among adults with CKD: a NHANES-based analysis
Frontiers in Cardiovascular Medicine
chronic kidney disease
cardiovascular risk factors
sex-differences
NHANES
hypertension
anaemia
title Differential cardiovascular risk profiles by sex among adults with CKD: a NHANES-based analysis
title_full Differential cardiovascular risk profiles by sex among adults with CKD: a NHANES-based analysis
title_fullStr Differential cardiovascular risk profiles by sex among adults with CKD: a NHANES-based analysis
title_full_unstemmed Differential cardiovascular risk profiles by sex among adults with CKD: a NHANES-based analysis
title_short Differential cardiovascular risk profiles by sex among adults with CKD: a NHANES-based analysis
title_sort differential cardiovascular risk profiles by sex among adults with ckd a nhanes based analysis
topic chronic kidney disease
cardiovascular risk factors
sex-differences
NHANES
hypertension
anaemia
url https://www.frontiersin.org/articles/10.3389/fcvm.2025.1544590/full
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