title: Sex Differences in the Incidence of Peripheral Artery Disease in the Chronic Renal Insufficiency Cohort.
abstract: BACKGROUND
  To define how the incidence of peripheral artery disease (PAD) in chronic kidney disease differs according to sex and age.
  
  
  RESULTS
  The Chronic Renal Insufficiency Cohort (CRIC) is a multicenter, prospective cohort study of chronic kidney disease participants. Fine and Gray methods were used to determine the cumulative incidence of PAD, defined by an ankle brachial index <0.90 or a confirmed PAD event, with death as a competing event. Adjusted subdistribution hazard ratios from the Fine and Gray model determined the risk of PAD according to sex. A priori, we hypothesized that the relationship between sex and cumulative incidence of PAD differed according to age. The mean age of the 3174 participants in this study was 56.6 years and consisted of 55% males. During a median follow-up of 5.9 years, 17.8% developed PAD, 13.0% were lost to follow-up and 11.1% died. Females had a 1.53-fold greater adjusted PAD risk compared with males (95% confidence interval, 1.27-1.84; P<0.001). These sex-related differences in PAD risk also differed by age (P=0.013). Women, compared with men were at a markedly increased risk for PAD at younger ages; however, at ages >70 years, the risk was similar across both the sexes. Older men had a substantially greater PAD risk compared with younger men. In women, PAD risk did not vary with age.
  
  
  CONCLUSIONS
  Females with chronic kidney disease have a higher PAD risk compared with males at younger ages. There is an important need to improve our understanding of the biological and clinical basis for these differences.
authors.affiliation: From the Departments of Surgery (G.J.W., R.M.F.), Biostatistics and Epidemiology (P.A.S., A.H.A., D.X., X.W., L.C.N., H.I.F.), and Medicine (R.R.T., E.R.M., B.K.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Medicine, Johns Hopkins Medicine, Baltimore, MD (S.M.S., B.G.J.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C.); Department of Medicine, Case Western Reserve University, Cleveland, OH (J.W.); Department of Nephrology and Hypertension, Cleveland Clinic, OH (J.J.T.); Department of Medicine, University of Michigan School of Medicine, Ann Arbor (A.O.); Department of Medicine, University of Illinois College of Medicine, Chicago (A.C.R.); and Tulane Office of Health Research, Tulane University Health Science Center, New Orleans, LA (E.L.). Grace.Wang@uphs.upenn.edu.
authors.forename: Grace J
authors.initials: GJ
authors.lastname: Wang
authors.affiliation: From the Departments of Surgery (G.J.W., R.M.F.), Biostatistics and Epidemiology (P.A.S., A.H.A., D.X., X.W., L.C.N., H.I.F.), and Medicine (R.R.T., E.R.M., B.K.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Medicine, Johns Hopkins Medicine, Baltimore, MD (S.M.S., B.G.J.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C.); Department of Medicine, Case Western Reserve University, Cleveland, OH (J.W.); Department of Nephrology and Hypertension, Cleveland Clinic, OH (J.J.T.); Department of Medicine, University of Michigan School of Medicine, Ann Arbor (A.O.); Department of Medicine, University of Illinois College of Medicine, Chicago (A.C.R.); and Tulane Office of Health Research, Tulane University Health Science Center, New Orleans, LA (E.L.).
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Shaw
authors.affiliation: From the Departments of Surgery (G.J.W., R.M.F.), Biostatistics and Epidemiology (P.A.S., A.H.A., D.X., X.W., L.C.N., H.I.F.), and Medicine (R.R.T., E.R.M., B.K.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Medicine, Johns Hopkins Medicine, Baltimore, MD (S.M.S., B.G.J.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C.); Department of Medicine, Case Western Reserve University, Cleveland, OH (J.W.); Department of Nephrology and Hypertension, Cleveland Clinic, OH (J.J.T.); Department of Medicine, University of Michigan School of Medicine, Ann Arbor (A.O.); Department of Medicine, University of Illinois College of Medicine, Chicago (A.C.R.); and Tulane Office of Health Research, Tulane University Health Science Center, New Orleans, LA (E.L.).
authors.forename: Raymond R
authors.initials: RR
authors.lastname: Townsend
authors.affiliation: From the Departments of Surgery (G.J.W., R.M.F.), Biostatistics and Epidemiology (P.A.S., A.H.A., D.X., X.W., L.C.N., H.I.F.), and Medicine (R.R.T., E.R.M., B.K.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Medicine, Johns Hopkins Medicine, Baltimore, MD (S.M.S., B.G.J.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C.); Department of Medicine, Case Western Reserve University, Cleveland, OH (J.W.); Department of Nephrology and Hypertension, Cleveland Clinic, OH (J.J.T.); Department of Medicine, University of Michigan School of Medicine, Ann Arbor (A.O.); Department of Medicine, University of Illinois College of Medicine, Chicago (A.C.R.); and Tulane Office of Health Research, Tulane University Health Science Center, New Orleans, LA (E.L.).
authors.forename: Amanda H
authors.initials: AH
authors.lastname: Anderson
authors.affiliation: From the Departments of Surgery (G.J.W., R.M.F.), Biostatistics and Epidemiology (P.A.S., A.H.A., D.X., X.W., L.C.N., H.I.F.), and Medicine (R.R.T., E.R.M., B.K.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Medicine, Johns Hopkins Medicine, Baltimore, MD (S.M.S., B.G.J.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C.); Department of Medicine, Case Western Reserve University, Cleveland, OH (J.W.); Department of Nephrology and Hypertension, Cleveland Clinic, OH (J.J.T.); Department of Medicine, University of Michigan School of Medicine, Ann Arbor (A.O.); Department of Medicine, University of Illinois College of Medicine, Chicago (A.C.R.); and Tulane Office of Health Research, Tulane University Health Science Center, New Orleans, LA (E.L.).
authors.forename: Dawei
authors.initials: D
authors.lastname: Xie
authors.affiliation: From the Departments of Surgery (G.J.W., R.M.F.), Biostatistics and Epidemiology (P.A.S., A.H.A., D.X., X.W., L.C.N., H.I.F.), and Medicine (R.R.T., E.R.M., B.K.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Medicine, Johns Hopkins Medicine, Baltimore, MD (S.M.S., B.G.J.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C.); Department of Medicine, Case Western Reserve University, Cleveland, OH (J.W.); Department of Nephrology and Hypertension, Cleveland Clinic, OH (J.J.T.); Department of Medicine, University of Michigan School of Medicine, Ann Arbor (A.O.); Department of Medicine, University of Illinois College of Medicine, Chicago (A.C.R.); and Tulane Office of Health Research, Tulane University Health Science Center, New Orleans, LA (E.L.).
authors.forename: Xue
authors.initials: X
authors.lastname: Wang
authors.affiliation: From the Departments of Surgery (G.J.W., R.M.F.), Biostatistics and Epidemiology (P.A.S., A.H.A., D.X., X.W., L.C.N., H.I.F.), and Medicine (R.R.T., E.R.M., B.K.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Medicine, Johns Hopkins Medicine, Baltimore, MD (S.M.S., B.G.J.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C.); Department of Medicine, Case Western Reserve University, Cleveland, OH (J.W.); Department of Nephrology and Hypertension, Cleveland Clinic, OH (J.J.T.); Department of Medicine, University of Michigan School of Medicine, Ann Arbor (A.O.); Department of Medicine, University of Illinois College of Medicine, Chicago (A.C.R.); and Tulane Office of Health Research, Tulane University Health Science Center, New Orleans, LA (E.L.).
authors.forename: Lisa C
authors.initials: LC
authors.lastname: Nessel
authors.affiliation: From the Departments of Surgery (G.J.W., R.M.F.), Biostatistics and Epidemiology (P.A.S., A.H.A., D.X., X.W., L.C.N., H.I.F.), and Medicine (R.R.T., E.R.M., B.K.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Medicine, Johns Hopkins Medicine, Baltimore, MD (S.M.S., B.G.J.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C.); Department of Medicine, Case Western Reserve University, Cleveland, OH (J.W.); Department of Nephrology and Hypertension, Cleveland Clinic, OH (J.J.T.); Department of Medicine, University of Michigan School of Medicine, Ann Arbor (A.O.); Department of Medicine, University of Illinois College of Medicine, Chicago (A.C.R.); and Tulane Office of Health Research, Tulane University Health Science Center, New Orleans, LA (E.L.).
authors.forename: Emile R
authors.initials: ER
authors.lastname: Mohler
authors.affiliation: From the Departments of Surgery (G.J.W., R.M.F.), Biostatistics and Epidemiology (P.A.S., A.H.A., D.X., X.W., L.C.N., H.I.F.), and Medicine (R.R.T., E.R.M., B.K.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Medicine, Johns Hopkins Medicine, Baltimore, MD (S.M.S., B.G.J.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C.); Department of Medicine, Case Western Reserve University, Cleveland, OH (J.W.); Department of Nephrology and Hypertension, Cleveland Clinic, OH (J.J.T.); Department of Medicine, University of Michigan School of Medicine, Ann Arbor (A.O.); Department of Medicine, University of Illinois College of Medicine, Chicago (A.C.R.); and Tulane Office of Health Research, Tulane University Health Science Center, New Orleans, LA (E.L.).
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Sozio
authors.affiliation: From the Departments of Surgery (G.J.W., R.M.F.), Biostatistics and Epidemiology (P.A.S., A.H.A., D.X., X.W., L.C.N., H.I.F.), and Medicine (R.R.T., E.R.M., B.K.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Medicine, Johns Hopkins Medicine, Baltimore, MD (S.M.S., B.G.J.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C.); Department of Medicine, Case Western Reserve University, Cleveland, OH (J.W.); Department of Nephrology and Hypertension, Cleveland Clinic, OH (J.J.T.); Department of Medicine, University of Michigan School of Medicine, Ann Arbor (A.O.); Department of Medicine, University of Illinois College of Medicine, Chicago (A.C.R.); and Tulane Office of Health Research, Tulane University Health Science Center, New Orleans, LA (E.L.).
authors.forename: Bernard G
authors.initials: BG
authors.lastname: Jaar
authors.affiliation: From the Departments of Surgery (G.J.W., R.M.F.), Biostatistics and Epidemiology (P.A.S., A.H.A., D.X., X.W., L.C.N., H.I.F.), and Medicine (R.R.T., E.R.M., B.K.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Medicine, Johns Hopkins Medicine, Baltimore, MD (S.M.S., B.G.J.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C.); Department of Medicine, Case Western Reserve University, Cleveland, OH (J.W.); Department of Nephrology and Hypertension, Cleveland Clinic, OH (J.J.T.); Department of Medicine, University of Michigan School of Medicine, Ann Arbor (A.O.); Department of Medicine, University of Illinois College of Medicine, Chicago (A.C.R.); and Tulane Office of Health Research, Tulane University Health Science Center, New Orleans, LA (E.L.).
authors.forename: Jing
authors.initials: J
authors.lastname: Chen
authors.affiliation: From the Departments of Surgery (G.J.W., R.M.F.), Biostatistics and Epidemiology (P.A.S., A.H.A., D.X., X.W., L.C.N., H.I.F.), and Medicine (R.R.T., E.R.M., B.K.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Medicine, Johns Hopkins Medicine, Baltimore, MD (S.M.S., B.G.J.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C.); Department of Medicine, Case Western Reserve University, Cleveland, OH (J.W.); Department of Nephrology and Hypertension, Cleveland Clinic, OH (J.J.T.); Department of Medicine, University of Michigan School of Medicine, Ann Arbor (A.O.); Department of Medicine, University of Illinois College of Medicine, Chicago (A.C.R.); and Tulane Office of Health Research, Tulane University Health Science Center, New Orleans, LA (E.L.).
authors.forename: Jackson
authors.initials: J
authors.lastname: Wright
authors.affiliation: From the Departments of Surgery (G.J.W., R.M.F.), Biostatistics and Epidemiology (P.A.S., A.H.A., D.X., X.W., L.C.N., H.I.F.), and Medicine (R.R.T., E.R.M., B.K.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Medicine, Johns Hopkins Medicine, Baltimore, MD (S.M.S., B.G.J.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C.); Department of Medicine, Case Western Reserve University, Cleveland, OH (J.W.); Department of Nephrology and Hypertension, Cleveland Clinic, OH (J.J.T.); Department of Medicine, University of Michigan School of Medicine, Ann Arbor (A.O.); Department of Medicine, University of Illinois College of Medicine, Chicago (A.C.R.); and Tulane Office of Health Research, Tulane University Health Science Center, New Orleans, LA (E.L.).
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Taliercio
authors.affiliation: From the Departments of Surgery (G.J.W., R.M.F.), Biostatistics and Epidemiology (P.A.S., A.H.A., D.X., X.W., L.C.N., H.I.F.), and Medicine (R.R.T., E.R.M., B.K.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Medicine, Johns Hopkins Medicine, Baltimore, MD (S.M.S., B.G.J.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C.); Department of Medicine, Case Western Reserve University, Cleveland, OH (J.W.); Department of Nephrology and Hypertension, Cleveland Clinic, OH (J.J.T.); Department of Medicine, University of Michigan School of Medicine, Ann Arbor (A.O.); Department of Medicine, University of Illinois College of Medicine, Chicago (A.C.R.); and Tulane Office of Health Research, Tulane University Health Science Center, New Orleans, LA (E.L.).
authors.forename: Akinlolu
authors.initials: A
authors.lastname: Ojo
authors.affiliation: From the Departments of Surgery (G.J.W., R.M.F.), Biostatistics and Epidemiology (P.A.S., A.H.A., D.X., X.W., L.C.N., H.I.F.), and Medicine (R.R.T., E.R.M., B.K.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Medicine, Johns Hopkins Medicine, Baltimore, MD (S.M.S., B.G.J.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C.); Department of Medicine, Case Western Reserve University, Cleveland, OH (J.W.); Department of Nephrology and Hypertension, Cleveland Clinic, OH (J.J.T.); Department of Medicine, University of Michigan School of Medicine, Ann Arbor (A.O.); Department of Medicine, University of Illinois College of Medicine, Chicago (A.C.R.); and Tulane Office of Health Research, Tulane University Health Science Center, New Orleans, LA (E.L.).
authors.forename: Ana C
authors.initials: AC
authors.lastname: Ricardo
authors.affiliation: From the Departments of Surgery (G.J.W., R.M.F.), Biostatistics and Epidemiology (P.A.S., A.H.A., D.X., X.W., L.C.N., H.I.F.), and Medicine (R.R.T., E.R.M., B.K.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Medicine, Johns Hopkins Medicine, Baltimore, MD (S.M.S., B.G.J.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C.); Department of Medicine, Case Western Reserve University, Cleveland, OH (J.W.); Department of Nephrology and Hypertension, Cleveland Clinic, OH (J.J.T.); Department of Medicine, University of Michigan School of Medicine, Ann Arbor (A.O.); Department of Medicine, University of Illinois College of Medicine, Chicago (A.C.R.); and Tulane Office of Health Research, Tulane University Health Science Center, New Orleans, LA (E.L.).
authors.forename: Eva
authors.initials: E
authors.lastname: Lustigova
authors.affiliation: From the Departments of Surgery (G.J.W., R.M.F.), Biostatistics and Epidemiology (P.A.S., A.H.A., D.X., X.W., L.C.N., H.I.F.), and Medicine (R.R.T., E.R.M., B.K.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Medicine, Johns Hopkins Medicine, Baltimore, MD (S.M.S., B.G.J.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C.); Department of Medicine, Case Western Reserve University, Cleveland, OH (J.W.); Department of Nephrology and Hypertension, Cleveland Clinic, OH (J.J.T.); Department of Medicine, University of Michigan School of Medicine, Ann Arbor (A.O.); Department of Medicine, University of Illinois College of Medicine, Chicago (A.C.R.); and Tulane Office of Health Research, Tulane University Health Science Center, New Orleans, LA (E.L.).
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Fairman
authors.affiliation: From the Departments of Surgery (G.J.W., R.M.F.), Biostatistics and Epidemiology (P.A.S., A.H.A., D.X., X.W., L.C.N., H.I.F.), and Medicine (R.R.T., E.R.M., B.K.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Medicine, Johns Hopkins Medicine, Baltimore, MD (S.M.S., B.G.J.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C.); Department of Medicine, Case Western Reserve University, Cleveland, OH (J.W.); Department of Nephrology and Hypertension, Cleveland Clinic, OH (J.J.T.); Department of Medicine, University of Michigan School of Medicine, Ann Arbor (A.O.); Department of Medicine, University of Illinois College of Medicine, Chicago (A.C.R.); and Tulane Office of Health Research, Tulane University Health Science Center, New Orleans, LA (E.L.).
authors.forename: Harold I
authors.initials: HI
authors.lastname: Feldman
authors.affiliation: From the Departments of Surgery (G.J.W., R.M.F.), Biostatistics and Epidemiology (P.A.S., A.H.A., D.X., X.W., L.C.N., H.I.F.), and Medicine (R.R.T., E.R.M., B.K.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Medicine, Johns Hopkins Medicine, Baltimore, MD (S.M.S., B.G.J.); Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C.); Department of Medicine, Case Western Reserve University, Cleveland, OH (J.W.); Department of Nephrology and Hypertension, Cleveland Clinic, OH (J.J.T.); Department of Medicine, University of Michigan School of Medicine, Ann Arbor (A.O.); Department of Medicine, University of Illinois College of Medicine, Chicago (A.C.R.); and Tulane Office of Health Research, Tulane University Health Science Center, New Orleans, LA (E.L.).
authors.forename: Bonnie
authors.initials: B
authors.lastname: Ky
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D012306:Risk; D012727:Sex Characteristics
keywords: ankle brachial index; epidemiology; mortality; peripheral artery disease; sex