Sex differences in the recognition, monitoring, and treatment of chronic kidney disease

A team led by Juan Jesus Carrero studied a variety of CKD-care indicators among 227,847 people with a first-ever detected low level of kidney function denoting probable CKD in Stockholm's health system from 2009–2017.

The investigators found that compared with men with similar characteristics, women were less likely to receive a diagnostic code related to CKD, be referred to a nephrologist, and have their kidney function monitored. Additionally, women were less likely to receive guideline-recommended medications.

"This study identifies healthcare gaps that may explain previously reported sex differences in the prevalence, progression rates, and outcomes of persons with chronic kidney disease," said Dr. Carrero

Analyses of time trends during the last decade showed that many indicators are improving over time—for example, there has been an increase in the rate of certain tests of kidney function over the years, but the rate of testing among women with CKD has been persistently lower than that of men.

"We are unable to identify the reasons for this potential under-management, and speculate on possible causes, such as challenges in interpreting serum creatinine— a marker of kidney function and a waste product of the normal wear and tear on muscles of the body—in women who on average are smaller and have lower muscle mass than men," one of the researchers noted.

"It is also possible that subconscious biases operate among healthcare professionals, believing that CKD is less problematic in women, or that women themselves are more likely to deny their disease. In any case, our study brings attention to healthcare gaps amenable to correction."