Study shows gender disparities in CKD detection and treatment

A research study conducted in Sweden and published in JASN, found that there are sweeping differences in the detection, monitoring, and management of chronic kidney disease (CKD) between sexes.1

Guidelines clearly establish the recommendations for screening, diagnostics, monitoring, and caring for people who are at risk of or who have established CKD.1 These recommendations are not based on sex, however, quality CKD health care is offered to more men than women, according to the study authors.1 They added that early detection is the key to preventing kidney failure that can lead to fatal heart disease.1,2

“We were expecting to find small or no disparities in how men and women were managed, because guidelines do not make distinctions by sex. Instead, we observed profound differences in the detection work up and management of chronic kidney disease suggesting suboptimal care among women. Surprisingly, these differences were observed across high-risk groups and indications, such as women with diabetes, macroalbuminuria, or advanced chronic kidney disease,” said lead study investigator Juan Jesus Carrero, PharmD, PhD, in a press release.1

Carrero and Oskar Swartling, an MD, PhD student at Karolinska Institutet in Sweden led the team of researchers.1 The team studied CKD-care indicators in 227,847 people from Stockholm’s health system who had probable CKD from 2009-2017.1

Women were found less likely than men to receive a CKD-related diagnostic code or nephrologist referral, have their kidney function monitored, or receive guideline-recommended medications, according to the researchers.1

“This study identifies health care gaps that may explain previously reported sex differences in the prevalence, progression rates, and outcomes of persons with chronic kidney disease,” Carrero said.1

CKD is a condition that causes an individual to gradually lose their kidney function over time.2 Up to 37 million American adults have CKD and millions more are at risk.2

Two-thirds of CKD cases are caused by diabetes and high blood pressure.2 Symptoms can include lethargy, trouble sleeping, nightly muscle cramping, dry and itchy skin, swollen feet and ankles, and trouble concentrating.2

Indicators for CKD have improved within the past decade, which includes the rate of administering certain kidney function tests; however, the tests continue to be administered to men more than women.1

“We are unable to identify the reasons between 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,” Swartling said. “It is also possible that subconscious biases operate among healthcare professionals, believing that CKD is less problematic in women, or that women themselves more likely deny their disease. In any case, our study brings attention to healthcare gaps amenable to correction.”1

The research is limited to Sweden, though isolated observations from the United Kingdom, United States, and Canada report sex gaps.1

References

1. Analysis reveals sex differences in the recognition, monitoring, and treatment of chronic kidney disease. EurekAlert! July 29, 2022. Accessed Aug. 1, 2022. https://www.eurekalert.org/news-releases/960001

2. National Kidney Foundation. Chronic kidney disease (CKD) - Symptoms, causes, treatment. National Kidney Foundation website. Accessed Aug. 1, 2022. https://www.kidney.org/atoz/content/about-chronic-kidney-disease