Association between sex, cardiovascular risk factors and mortality, in chronic kidney disease patients: insights from the NHANES dataset (2007-2018)

<p dir="ltr">Individuals with chronic kidney disease (CKD) have a 10-fold increased risk of cardiovascular mortality, compared to age-matched controls. This heightened risk is partially attributed to shared risk factors such as hypertension, diabetes, and dyslipidaemia, which present and affect females and males with CKD differently. However, the existing evidence on these sex-related disparities in CKD is inconsistent. Therefore, this thesis explores the interplay between sex, cardiovascular risk factors, and cardiovascular mortality in individuals with and without CKD. It comprises two distinct aims:</p><ul><li>Aim 1: To investigate the association between specific cardiovascular risk factors and cardiovascular mortality among individuals with CKD compared to those without CKD, with separate analyses for females and males.</li><li>Aim 2: To determine whether females or males with and without CKD have a higher likelihood of exhibiting these cardiovascular risk factors.</li></ul><p dir="ltr">A cross-sectional analysis was undertaken utilising data from the National Health and Nutrition Examination Survey (NHANES). This survey is conducted biennially as a cross-sectional survey, with each cycle enrolling new participants. This survey assesses the health and nutritional status of the United States population, with participants' data linked to pathology results and death registries. For aim 1, multivariable logistic regression was used to determine the association between various cardiovascular risk factors and cardiovascular mortality among CKD and non-CKD groups. This analysis was repeated after stratification by sex. For aim 2, multivariable logistic regression was used to determine the association between sex and various cardiovascular risk factors in CKD and non-CKD groups.</p><p dir="ltr">Of the 30,804 participants from 2007 to 2018, 5,528 had CKD. Notably, in individuals with CKD, diabetes (OR: 1.45, CI: 1.16-1.82), hypertension (OR: 1.61, CI: 1.14-2.27), low haemoglobin (OR: 2.14, CI: 1.50-3.06), low haematocrit (OR: 1.85, CI: 1.36-2.52) and low albumin (OR: 2.70, CI: 1.33-5.44) were associated with cardiovascular mortality. For females with CKD, increased odds of cardiovascular mortality were associated with diabetes (OR: 1.67, CI: 1.10-2.53), hypertension (OR: 2.18, CI: 1.23-3.85), low HDL-C (OR: 1.47, CI: 1.01-2.14), low haemoglobin (OR: 2.17, CI: 1.35-3.48) and low haematocrit (OR: 1.77, CI: 1.16-2.71). Males with CKD exhibited increased odds of cardiovascular mortality with low haemoglobin (OR: 2.28, CI: 1.47-3.53), low haematocrit (OR: 2.01, CI: 1.40-2.89) and low albumin (OR: 4.05, CI: 1.64-9.99). Compared to males with CKD, females with CKD demonstrated reduced odds for diabetes (OR: 0.54, CI: 0.43-0.67), hypertension (OR: 0.81, CI: 0.67-0.98), low haematocrit (OR: 0.48, CI: 0.40-0.57), and elevated triglycerides (OR: 0.75, CI: 0.63-0.88). Contrastingly, females with CKD exhibited increased odds of high waist circumference (OR: 1.69, CI: 1.40-2.04) compared to males with CKD.</p><p dir="ltr">Hypertension, diabetes, anaemia, and low albumin were highlighted as salient cardiovascular risk factors in the context of CKD. Notably, we underscore the significance of these risk factors in females with CKD as opposed to their male counterparts. Ultimately, this study has the potential to inform the management strategies for patients with CKD and various sex and cardiovascular risk factor profiles.</p>