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

Rui Du1,2, Hannah Wallace2, Jeffrey T Ha2,3

  • 1School of Basic Medical Science, Tsinghua Medicine, Tsinghua University, Beijing, China.

Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association
|June 19, 2026
PubMed

Insights

Female patients with chronic kidney disease (CKD) receive evidence-based medications like renin-angiotensin system inhibitors (RASi) and sodium glucose co-transporter 2 inhibitors (SGLT2i) less often than males. These disparities persist regardless of risk factors, suggesting potential global treatment inequities.

Area of Science:

  • Nephrology
  • Public Health
  • Health Equity

Background:

  • Chronic kidney disease (CKD) presents a significant and increasing global health challenge.
  • Existing research indicates sex disparities in CKD prevalence and patient outcomes.
  • However, comprehensive data on sex-based differences in the therapeutic management of CKD is limited.

Purpose of the Study:

  • To investigate and quantify sex disparities in the utilization of evidence-based medications among a diverse global cohort of patients with CKD.
  • To identify if these disparities are influenced by key clinical characteristics such as age, disease severity, and comorbidities.

Main Methods:

  • Analysis of a prospective, observational, international cohort (Global Kidney Patient Trials Network - GKPTN) of CKD patients.
  • Primary exposure: biological sex. Primary outcomes: receipt of renin-angiotensin system inhibitors (RASi), sodium glucose co-transporter 2 inhibitors (SGLT2i), and diuretics.
  • Adjusted multivariable logistic regression models were employed to assess the association between sex and medication receipt, controlling for covariates and examining interactions with clinical factors.

Main Results:

  • The study included 4192 participants, with females comprising 40.9%.
  • Females demonstrated significantly lower odds of receiving RASi (OR=0.75, P<0.001) and SGLT2i (OR=0.79, P=0.03) compared to males, even after multivariable adjustment.
  • No significant sex difference was observed in the receipt of diuretics, and no significant interactions were found between sex and other clinical characteristics.

Conclusions:

  • Female CKD patients are less likely to be prescribed guideline-recommended medications, specifically RASi and SGLT2i, compared to their male counterparts.
  • These observed sex-based disparities in medication use are consistent across various risk profiles and may contribute to differential health outcomes.
  • The findings underscore the need to address potential inequities in CKD treatment globally to improve patient care and outcomes.
Abstract

Keywords:
CKDchronic renal insufficiencydiureticsgenderhypertension

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