Although chronic kidney disease (CKD) care has improved over time, women are less likely than men to be diagnosed with CKD and have their kidney function monitored, a new Swedish study finds. They are also less likely to be referred to a nephrologist and receive guideline-recommended medications.
The disparities are not explained by comorbidity burden, according to investigators.
Using data from the 2009-2017 Stockholm Creatinine Measurements (SCREAM) project, investigators identified 126,289 women (55%) and 101,558 men (45%) with an initial estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m2. Over the following 18 months, women were 52% less likely to receive a CKD diagnosis, 19% less likely to have a repeat serum creatinine measurement, and 11% less likely to have albuminuria measurement, compared with men, in adjusted analyses, Juan Jesus Carrero, Pharm, PhD, Oskar Swartling, MD, PhD student, from Karolinska Institutet in Stockholm, Sweden, and colleagues reported in the Journal of the American Society of Nephrology. Results were consistent across CKD categories, albuminuria status, age groups, and comorbidity burden (including hypertension, diabetes, and cardiovascular disease). All results were statistically significant.
The investigators emphasized that late nephrology referral is associated with faster CKD progression and worse outcomes. Results showed that women were 42% less likely to receive a nephrology referral during follow-up compared with men. Among patients with stage 5 CKD, women were 23% less likely than men to see a nephrologist in adjusted analyses. The team continued to observe sex-based disparities among a subset of patients who met at least one criterion for nephrology referral according to guidelines from Kidney Disease Improving Global Outcomes (KDIGO).
Renin-angiotensin-system inhibitors and statins are guideline-recommended therapies for CKD. Women had 32% and 22% decreased odds of receiving these medications, respectively, compared with men.
Dr Carrero’s team pointed out that sex differences in CKD care persisted over time and were present among patients with a formal CKD diagnosis, high-risk groups such as women with diabetes, moderate to severe albuminuria, and advanced CKD, and those with evidence-based indications for medications.
“We were expecting to find small or no disparities in how men and women were managed, because guidelines do not make distinctions by sex,” Dr Carrero noted in a prepared statement. “Instead, we observed profound differences in the detection work up and management of chronic kidney disease suggesting suboptimal care among women.”
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Swartling O, Yang Y, Clase CM, et al. Sex differences in the recognition, monitoring, and management of CKD in health care: an observational cohort study. J Am Soc Nephrol. Published online July 29, 2022. doi:10.1681/ASN.2022030373
Analysis reveals sex differences in the recognition, monitoring, and treatment of chronic kidney disease. News release. American Society of Nephrology; July 26, 2022.