Sex disparities in receiving evidence-based medications in patients with CKD.

BACKGROUND AND HYPOTHESIS: Chronic kidney disease (CKD) is a growing global health burden. While studies have demonstrated sex disparities in CKD prevalence and outcomes, evidence on sex-based differences in therapeutic management remains limited. This analysis aims to assess sex disparities in the receipt of evidence-based medications in a global CKD cohort.

METHODS

This study is a sub-study of the Global Kidney Patient Trials Network (GKPTN), a prospective, observational, international cohort of CKD patients. The exposure of this study is biological sex, and the main outcomes are the receipt of evidence-based medications for CKD, including renin-angiotensin system inhibitors (RASi), sodium glucose co-transporter 2 inhibitor (SGLT2i) and diuretics. Adjusted multivariable logistic models were conducted to examine associations between sex and proportion of receiving medications, as well as the interactions between sex and other key clinical characteristics (advanced age, high KDIGO prognosis risk, and comorbid condition).

RESULTS

A total of 4192 participants were eligible, and 40.9% were female. Females had lower odds of receiving RASi (OR = 0.75, 95% CI 0.64-0.88; P < 0.001) and SGLT2i (OR = 0.79, 95% CI 0.64-0.98; P = 0.03) compared to males, after adjusting for age, region, systolic blood pressure (SBP), body mass index (BMI), presence of cardiovascular disease and diabetes, CKD aetiology and prognosis risk, with no significant difference in the receipt of diuretics. There were no significant interactions between sex and any other key clinical characteristics, indicating that the disparities in the receipt of RASi and SGLT2i remained consistent across high-risk subgroups.

CONCLUSION

Female patients with CKD are less likely to receive evidence-based medications than males, irrespective of established CKD risk factors. This difference highlights potential inequities in treatment globally which may result in outcome disparities.