Sex differences in patterns of chronic kidney disease care in Australian primary care: A retrospective cohort study of a national general practice dataset.

AIMS: Prevalence of chronic kidney disease (CKD) differs between females and males across the disease spectrum. Data on whether management of CKD also varies according to sex are limited. This study aimed to understand sex-related differences in CKD monitoring and cardiovascular risk management in Australian primary care.

MATERIALS AND

METHODS

Retrospective cohort study of adults attending general practices in Australia between 1 January 2011 and 30 June 2020 and met diagnostic criteria for CKD. Sex differences in CKD monitoring and management were assessed within 18 months of meeting CKD diagnostic criteria. Core monitoring was defined as ≥1 measurement of all of blood pressure, estimated glomerular filtration rate, urine albumin creatine ratio, lipids and, in patients with diabetes, haemoglobin A1c (HbA1c). Cardiovascular risk management comprised angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (ACEi/ARB) and statin prescriptions, blood pressure target achievement, and lipid control. Adjusted modified Poisson regression determined the relative risk (RR) of outcomes in females versus males, and sex-specific analyses explored associations between patient characteristics and outcomes.

RESULTS

Of 140 774 patients with CKD, 51.4% were female. Females were older (mean age: 75.8 vs. 72.7 years) and had less prevalent cardiovascular disease and diabetes. Females were less likely than males to receive core monitoring in models adjusted for clinical and sociodemographic characteristics (RR [95% CI], 0.96 [0.95-0.98]), ACEi/ARB prescription (0.96 [0.95-0.97]; no difference in statin prescription), blood pressure targets (<140/90 mmHg: 0.96 [0.95-0.97]), and LDL <2 mmol/L (0.82 [0.80-0.84]). Differences persisted with advancing age, higher CKD risk, and co-morbidity subgroups. Sex-specific analyses found similar associations between patient characteristics and CKD care in both females and males.

CONCLUSIONS

Females with CKD were less likely to receive CKD monitoring and cardiovascular risk management compared to males. Findings were not explained by differences in sociodemographic and clinical characteristics, with findings persisting in both high-risk subgroups and adjusted models. Further research is required to understand reasons for disparities in care.