Gender disparities in Swedish specialized nephrology care

Although women have more prevalent chronic kidney disease (CKD) they less often have recommended therapy or a documented CKD diagnosis in primary care. This study investigates whether gender disparities remain in specialized nephrology care as a possible expression of gender bias.

Patients with incident estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m² registered in the Swedish Renal Registry between 2010 and 2020 were included. Logistic regression investigated gender differences in having a CKD diagnosis, kidney biopsy, blood pressure (BP) <140/90 mmHg and guideline-recommended medications. Gender disparities regarding kidney replacement therapy (KRT) initiation, including preemptive kidney transplantation and initiating dialysis with a planned access, were investigated using flexible parametric regression and Cox regression.

Of 25 478 included patients 37% were female. Women were less likely to have a CKD diagnosis [odds ratio (OR) 0.81, 95% confidence interval 0.73-0.90], a renin-angiotensin-aldosterone inhibitor (OR 0.94, 0.89-0.99), lipid-lowering agent (OR 0.93, 0.88-0.99) or BP <140/90 mmHg (OR 0.91, 0.86-0.97). Women had borderline-significantly lower odds of having a kidney biopsy (OR 0.93, 0.86-1.00). Women were less likely to initiate KRT, [hazard ratio (HR) 0.75, 0.70-0.80] or to initiate dialysis with a planned access (HR 0.82, 0.78-0.85). No significant gender differences were seen regarding preemptive transplantation and conservative kidney management decision. Women less often died before KRT initiation (HR 0.81, 0.77-0.85).

Swedish women with advanced CKD in specialized nephrology remain underdiagnosed, undertreated and less likely to reach BP targets. Although these gender differences did not translate to increased KRT and mortality rates, they highlight the need for nephrologists to maintain awareness and strive for health equity.