Sex Differences in Baseline Characteristics and Long-Term Outcomes of Primary Glomerular Diseases: Insights from the TSN-GOLD Registry

Background: Primary glomerular diseases (PGDs) are a leading cause of end-stage kidney disease (ESKD). While sex differences in chronic kidney disease progression have been reported, their role in PGDs remains unclear. Methods: We analyzed 2081 patients with biopsy-proven PGDs from the Turkish Society of Nephrology Glomerular Diseases Working Group (TSN-GOLD) registry. Baseline demographic, clinical, biochemical, and histopathological characteristics were compared between women and men. Outcomes were assessed as a composite of ESKD or death. Logistic and Cox regression models were applied to identify independent risk factors. Kaplan–Meier analyses evaluated survival differences. Results: At baseline, women and men had similar rates of hypertension (36.8% vs. 34.7%, p = 0.322). Women more frequently presented with leukocyturia (31.7% vs. 17.2%, p < 0.001) and hematuria (57.8% vs. 52.3%, p = 0.016), whereas men had higher proteinuria (5011 ± 4925 vs. 4388 ± 4529 mg/day, p = 0.003) and were more likely to be active smokers (20.7% vs. 7.4%, p < 0.001). Serum albumin (3.3 ± 0.8 vs. 3.2 ± 0.9 g/dL) and eGFR (79.7 ± 44.3 vs. 78.7 ± 45.5 mL/min/1.73 m2) were comparable between sexes (both NS). During a median follow-up of 24 months (IQR 7-60), 431 patients (20.7%) reached the composite outcome of ESKD or death (137 deaths [6.6%], 294 ESKD [14.1%]). In the multivariable Cox regression model, lower baseline eGFR (HR 0.98, 95% CI 0.98–0.98, p < 0.001), lower serum albumin (HR 0.65, 95% CI 0.55–0.77, p < 0.001), higher proteinuria (HR 1.03, 95% CI 1.00–1.05, p = 0.043), and biopsy diagnosis of RPGN (HR 3.78, 95% CI 1.37–10.45, p = 0.010) were independent predictors of poor prognosis. Sex was not an independent predictor of outcome (p = 0.48). Kaplan–Meier analysis demonstrated no significant survival difference between women and men (log-rank p = 0.052). Conclusions: In this nationwide PGD cohort, women and men differed significantly in baseline biochemical and clinical parameters, yet sex was not independently associated with progression to ESKD or death. Instead, disease severity at baseline and histopathological features were the main drivers of prognosis.

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Journal
Journal of Clinical Medicine
Published
2026-05-22
DOI
https://doi.org/10.3390/jcm15114017
Primary Topic
Renal Diseases and Glomerulopathies
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article
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article

Sex Differences in Baseline Characteristics and Long-Term Outcomes of Primary Glomerular Diseases: Insights from the TSN-GOLD Registry

Melike Betül Öğütmen, Alper Azak, Zeki Aydın, Düriye Deren Oygar et al.
Journal of Clinical Medicine
Renal Diseases and Glomerulopathies
article

Sex Differences in Baseline Characteristics and Long-Term Outcomes of Primary Glomerular Diseases: Insights from the TSN-GOLD Registry

Melike Betül Öğütmen, Alper Azak, Zeki Aydın, Düriye Deren Oygar, Şeyda Gül Özcan, Ahmet Burak Dirim, Murat Duranay, Sabahat Alışır Ecder, Zeki Kemeç, Dilek Güven Taymez, Erkan Şengül, Nurhan Bilen, Onur Tunca, İlhan Kurultak, Ahmet Kıykım, Nimet Aktaş, Di̇lek Torun, Mevlüt Tamer Dinçer, Mehmet Tanrısev, Engin Onan, Ece Ük, Serap Demir, Arzu Özdemir, EZGİ COŞKUN YENİGÜN, Gülizar ŞAHİN, Serap Yadigar, Hamad Dheir, Musa Pınar, Metin Ergul, Mehmet Deniz Aylı, Ozkan Gungor, Necmi Eren, Meltem Gursu, Taner Basturk, Ozant Helvacı, Tugba Elif Ozler, Nedim Yılmaz Selcuk, Gizem Kumru, Halime Soyak Kabaca, Kultigin Turkmen, Erhan Tatar, Savas Ozturk, Sim Kutlay, Bulent Kaya
article en

Abstract

Background: Primary glomerular diseases (PGDs) are a leading cause of end-stage kidney disease (ESKD). While sex differences in chronic kidney disease progression have been reported, their role in PGDs remains unclear. Methods: We analyzed 2081 patients with biopsy-proven PGDs from the Turkish Society of Nephrology Glomerular Diseases Working Group (TSN-GOLD) registry. Baseline demographic, clinical, biochemical, and histopathological characteristics were compared between women and men. Outcomes were assessed as a composite of ESKD or death. Logistic and Cox regression models were applied to identify independent risk factors. Kaplan–Meier analyses evaluated survival differences. Results: At baseline, women and men had similar rates of hypertension (36.8% vs. 34.7%, p = 0.322). Women more frequently presented with leukocyturia (31.7% vs. 17.2%, p < 0.001) and hematuria (57.8% vs. 52.3%, p = 0.016), whereas men had higher proteinuria (5011 ± 4925 vs. 4388 ± 4529 mg/day, p = 0.003) and were more likely to be active smokers (20.7% vs. 7.4%, p < 0.001). Serum albumin (3.3 ± 0.8 vs. 3.2 ± 0.9 g/dL) and eGFR (79.7 ± 44.3 vs. 78.7 ± 45.5 mL/min/1.73 m2) were comparable between sexes (both NS). During a median follow-up of 24 months (IQR 7-60), 431 patients (20.7%) reached the composite outcome of ESKD or death (137 deaths [6.6%], 294 ESKD [14.1%]). In the multivariable Cox regression model, lower baseline eGFR (HR 0.98, 95% CI 0.98–0.98, p < 0.001), lower serum albumin (HR 0.65, 95% CI 0.55–0.77, p < 0.001), higher proteinuria (HR 1.03, 95% CI 1.00–1.05, p = 0.043), and biopsy diagnosis of RPGN (HR 3.78, 95% CI 1.37–10.45, p = 0.010) were independent predictors of poor prognosis. Sex was not an independent predictor of outcome (p = 0.48). Kaplan–Meier analysis demonstrated no significant survival difference between women and men (log-rank p = 0.052). Conclusions: In this nationwide PGD cohort, women and men differed significantly in baseline biochemical and clinical parameters, yet sex was not independently associated with progression to ESKD or death. Instead, disease severity at baseline and histopathological features were the main drivers of prognosis.

Journal of Clinical MedicineVol. 15(11)
Sakarya University (TR), Balıkesir University (TR), Trakya University (TR), Ministry of Health (TR), Bursa Uludağ Üni̇versi̇tesi̇ (TR), Izmir University (TR), Ankara University (TR), Bilkent University (TR), University of Health Science (KH), Başkent University (TR), Bursa Technical University (TR), State Hospital (GB), Bezmiâlem Vakıf Üniversitesi (TR), Batman University (TR), Memorial Ankara Hospital (TR), Dr Lütfi Kırdar Kartal Eğitim ve Araştırma Hastanesi (TR), Necmettin Erbakan University (TR), Sina Hospital (IR), Haseki Eğitim ve Araştırma Hastanesi (TR), Istanbul University-Cerrahpaşa (TR), Bakırköy Dr.Sadi Konuk Eğitim ve Araştırma Hastanesi (TR), Haydarpaşa Numune Eğitim ve Araştırma Hastanesi (TR), Başkent University Hospital (TR), Sağlık Bilimleri Üniversitesi (TR), Universidad CES (CO), Kartal Koşuyolu High Specialization Training and Research Hospital (TR), Farabi Hastanesi (TR), Şişli Etfal Eğitim ve Araştırma Hastanesi (TR), S.B.Ü. Bursa Yüksek İhtisas Eğitim ve Araştırma Hastanesi (TR), Afyonkarahisar Sağlık Bilimleri Üniversitesi, Kahramanmaraş Sütçü İmam University (TR), Mersin Üniversitesi (TR), Kocaeli Üniversitesi (TR), Afyon Kocatepe University (TR), Cukurova University (TR), Istanbul Medeniyet University (TR), Istanbul University (TR), University of Health Sciences Antigua (AG), Gazi University (TR)
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Renal Diseases and Glomerulopathies
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