Publication Description
Context: Despite sex differences in the onset and progression of CKD, it is unclear whether endogenous sex hormones are associated with kidney function among persons without chronic kidney disease (CKD). Research Design and Methods: We conducted a secondary analysis of Diabetes Prevention Program (DPP) and its follow-up observational study, the DPP Outcomes Study (DPPOS), over an 11-year period. Participants included overweight and glucose-intolerant men (n=889) and premenopausal and postmenopausal women (n=1281) not using exogenous sex hormones and who had urine albumin-to-creatinine ratio (ACR) 60 ml/min/1.73 m2 at randomization. We examined the association between sex hormones and incidence of eGFR 30 mg/g on at least one measurement. Results: At randomization, the mean (SD) of eGFR was 94 (15) ml/min/1.73 m2, and the median (IQR) of ACR was 4.5 (3.3-7.6) mg/g. During follow-up, 187 men (24.6%) and 263 women (24.2%) had incident albuminuria and 136 men (17.9%) and 123 women (11.3%) had incident low eGFR. Among men, higher baseline sex hormone binding globulin (SHBG) was associated with reduced risk of low eGFR (hazard ratio [HR] per SD, 95% confidence interval [CI]: 0.80 [0.57, 0.90]) in adjusted analyses. No significant associations were observed among women. There were significant interactions between sex steroids and low eGFR by randomization arm. Conclusions: Sex steroids were not associated with development of low eGFR or albuminuria. Among men, higher SHBG was associated with reduced risk of low eGFR on at least one measurement.