Study reveals gender differences in detection, monitoring and management of chronic kidney disease in Sweden
New research published in YES reveals profound gender differences in detection, monitoring and management of chronic kidney disease (CKD) in Sweden. Efforts to ensure gender equality of care could have important implications for reducing the burden of chronic vagal disease in this country and elsewhere.
Worldwide, there are gender differences in the causes, prevalence rates, progression and outcomes of people with CKD that can be explained by biological differences between men and women, but also by differences in the quality of care given to them. Importantly, guidelines have well-defined recommendations on how to screen, diagnose, monitor and care for individuals at risk of CKD or with established CKD, and these recommendations are not gender specific.
A team led by Juan Jesus Carrero, Pharm, PhD and Oskar Swartling, MD, PhD (Karolinska Institutet, Sweden) studied a variety of CKD care indicators among 227,847 people with a first-detected low level of kidney function indicating probable CKD in Stockholm’s healthcare 2009–2017.
The investigators found that compared to 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. In addition, women were less likely to receive guideline-recommended medications.
We expected to find little or no difference in how men and women were managed, as guidelines do not differentiate by gender. Instead, we observed large disparities in the detection and management of CKD, 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. This study identifies healthcare gaps that may explain previously reported gender differences in prevalence, progression rates and outcomes for people with chronic kidney disease.”
Dr. Juan Jesus Carrero, Pharm, PhD
Analyzes of time trends over the past decade showed that many indicators are improving over time—for example, there has been an increase in the frequency of certain tests of kidney function over the years, but the frequency of testing among women with CKD has been consistently lower than among men.
“We cannot identify the reasons between this potential under-management and speculate about possible causes, such as challenges in interpreting serum creatinine – a marker of kidney function and a waste product of normal wear and tear on the body’s muscles -; in women who are on average smaller and have lower muscle mass than men,” says Swartling. “It is also possible that subconscious biases operate among healthcare professionals, who believe that CKD is less of a problem in women, or that women themselves are more likely to deny their disease. In any case, our study draws attention to shortcomings in care that can be corrected.”
Although it is unclear whether the findings are generalizable to other health systems, isolated observations in other reports support the existence of such gender differences in the UK, Canada and the US.
Source:
Journal reference:
Swartling, O., et al. (2022) Gender differences in recognition, surveillance and management of CKD in health care: an observational cohort study. Journal of the American Society of Nephrology. doi.org/10.1681/ASN.2022030373.