Women less likely to receive CKD diagnosis code, referral, recommended medications

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The detection, recognition, follow-up, referrals and management of chronic kidney disease differ significantly between men and women, according to data published in the Journal of the American Society of Nephrology.

In addition, women were significantly less likely to receive a CKD diagnosis code or appropriate care compared to men.

In addition, women were less likely to undergo creatinine or albuminuria monitoring. Data were derived from Swartling O, et al. J Am Soc Nephrol. 2022; doi:10.1681/ASN.2022030373.

“CKD is prevalent and affects 8-16% of adults worldwide (11.8% of all women, 10.4% of all men), conferring large [health care] costs, and contributing to excess comorbidity and death,” wrote Oskar Swartling, MD, of the division of clinical epidemiology at the Karolinska Institute’s department of medicine in Sweden, and colleagues. They added: “While the majority of people with CKD are identified, followed and managed in the primary care setting, the evidence for differences by sex or gender comes mainly from the minority of patients referred to specialist nephrology units.”

In a healthcare-based study, researchers assessed differences in the recognition, detection, monitoring, and management of CKD between men and women. The study consisted of 227,847 adults (55% women) with at least one ambulatory GFR less than 60 mL/min/1,732 indicating possible CKD between 2009 and 2017. All data were derived from the Stockholm Creatinine Measurements project ( SCREAM).

The researchers determined the odds of having received a diagnosis of CKD and provision of renin-angiotensin inhibitors (RASi) and statins at inclusion. In addition, they calculated hazard ratios for receiving a diagnosis of CKD, visiting a nephrologist, or having creatinine and albuminuria monitored during follow-up.

Compared with men, women were less likely to receive a diagnosis code for CKD (6.9% of men vs. 3.4% of women) and to receive RASi and statins at inclusion. Time-to-event analyzes revealed that women were less likely to receive a diagnosis of CKD and visit a nephrologist regardless of disease severity, the presence of albuminuria, or a referral. Similarly, women were less likely to undergo creatinine or albuminuria monitoring, including those with diabetes or hypertension.

The researchers noted that the differences remained among those with confirmed CKD at retest after adjusting for comorbidities, albuminuria, and higher educational attainment.

“[…] we observed profound sex differences in detection, recognition and follow-up that persisted over time: women were less likely to receive a diagnosis of CKD, to visit a nephrologist, to have their creatinine and albuminuria or receiving guideline-recommended therapies,” Swartling and colleagues wrote.

In a press release, co-author Juan J. Carrero, PhD, added, “We expected to find little or no disparity in how men and women were managed, because the guidelines do not distinguish by sex. Instead, we observed profound differences in CKD detection and management work suggesting suboptimal care among women Surprisingly, these differences were seen in high-risk groups and indications, such as women with diabetes, macroalbuminuria, or advanced CKD “.

Reference:

Analysis reveals gender differences in recognition, monitoring and treatment of chronic kidney disease. Published July 29, 2022. Accessed July 29, 2022.

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