TOPLINE:

Among older adults with advanced chronic kidney disease (CKD), women had a higher symptom burden than men, but men showed faster symptom progression over time and with a decline in kidney function.

METHODOLOGY:

• Researchers conducted a prospective cohort study to describe longitudinal trajectories of symptom burden in older adults with advanced CKD and how symptoms change as kidney function declines.
• They included 1135 patients aged 65 years or older with an incident estimated glomerular filtration rate (eGFR) < 20 mL/min/1.73 m² who were not undergoing dialysis, of whom 775 were men.
• Clinical, demographic, and laboratory data were collected; symptom burden was self‑reported using the Dialysis Symptom Index, which captured the presence and severity of 30 symptoms over the prior month.
• Participants were followed up for up to 5 years or until the initiation of kidney replacement therapy, with study visits and data collection scheduled at 3- to 6-month intervals.

TAKEAWAY:

• During follow-up, 4730 symptom measurements were collected, and the number of symptoms increased on average by 0.47 (95% CI, 0.37-0.58) symptoms per year.
• Women reported more symptoms at baseline (mean, 13.6 vs 10.9) and throughout follow-up, but the average rate of increase in symptom number was over twice as fast in men (0.58 per year; 95% CI, 0.45-0.71) as in women (0.24 per year; 95% CI, 0.05-0.44).
• Symptom burden rose by 0.75 per 5 mL/min/1.73 m² decrease in eGFR; this increase was nearly threefold higher in men than in women (0.97; 95% CI, 0.78-1.16 vs 0.34; 95% CI, 0.03-0.64).
• The increase in symptom burden with declining kidney function followed a non-linear pattern, with a marked steepening of symptom number and severity noted especially in men at lower eGFR levels.

IN PRACTICE:

"Despite women reporting an overall higher symptom burden, the increase in symptom burden over time was twice as fast in men during follow-up, and almost three times faster in men when evaluated over eGFR decline," the authors wrote.

"Individual symptom profiles are heterogeneous, which emphasizes the importance of measuring symptom burden using PROMs [patient-reported outcome measures] in routine nephrology care to help identify therapeutic targets and personalize treatment approaches," they added.

SOURCE:

This study was led by Nicholas C. Chesnaye, University of Amsterdam, Amsterdam, Netherlands. It was published online on March 18, 2026, in Nephrology Dialysis Transplantation.

LIMITATIONS:

The study could not capture the complex interplay between biological sex-related and psychosocial gender-related factors. Missing questionnaires during follow-up reduced the sample size and may have introduced selection bias. Additionally, the eGFR is a poor indicator of kidney function at lower levels, which may have influenced the study's findings.

DISCLOSURES:

This study received funding from the European Renal Association and contributions from the Swedish Medical Association, Stockholm County Council, Centre for Innovative Research, Italian Society of Nephrology, and other sources. Some authors reported serving in unpaid advisory or leadership roles for professional societies; receiving research funding from public and industry sources, institutional grants, payments for lectures, and honoraria; having consultancy agreements; participating on steering committees and editorial boards; and serving in leadership roles within professional organisations.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.