Sex and gender differences in ambulatory care of chronic kidney disease

In chronic kidney disease (CKD) healthcare, there are significant gender-specific differences in the diagnosis, monitoring, and management of CKD. Women with CKD receive poorer healthcare compared to men with CKD. Women less frequently receive a diagnosis of CKD, are less frequently referred to nephrology for co-management, less frequently undergo estimated glomerular filtration rate (eGFR) and albuminuria assessments, and are less likely to receive guideline-recommended treatment for CKD, such as angiotensin-converting enzyme (ACE) inhibitors, sartans and statins. Cardiovascular risk factors are less rigorously controlled in women with CKD compared to men with CKD. The reasons for the poorer treatment of CKD among women are to be found in the gender rather than in biological factors. The determination of gender should be part of clinical routines and prospective studies. Gender-specific analyses should be standard in all studies. Premenopausal and postmenopausal women should be evaluated separately. The use of gender scores enables recognition of the influence of cultural, societal, and psychological factors on observed gender differences in outpatient healthcare for people with CKD. Guidelines should be gender-sensitive and highlight gaps in knowledge about gender differences in CKD healthcare. A substantial improvement and assurance of equitable healthcare for CKD between genders are urgently needed.