Human kidney cross section on scientific background
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Sex differences in chronic kidney disease have puzzled researchers for years. Although women are more likely to suffer from chronic kidney disease than men, men are more likely to receive aggressive treatments. For years, researchers have speculated that this is due to women choosing more conservative treatments or men having a more rapid deterioration in kidney function. But new research shows that bias in the healthcare setting may be to blame.

A new study, published in the Journal of the American Society of Nephrology, shows that there are major discrepancies in the way women with known or suspected kidney disease are managed in the healthcare setting in Sweden. The study finds that women were less likely than men to receive a diagnosis, visit a nephrologist, have their creatinine and albuminuria measured and receive guideline-recommended therapies. The findings shed new light on bias in the healthcare system.

“We were expecting to find small or no disparities in how men and women were managed, because guidelines do not make distinctions by sex. Instead, we observed profound differences in the detection workup and management of chronic kidney disease suggesting suboptimal care among women. Surprisingly, these differences were observed across high-risk groups and indications, such as women with diabetes, macroalbuminuria, or advanced chronic kidney disease,” said Juan-Jesus Carrero, professor of epidemiology at the Karolinska Institute in Sweden and senior author of the study.

Chronic kidney disease affects between eight and 16 percent of adults worldwide, imparting large health care costs and significant contributions to excess mortality. The proportion of women with chronic kidney disease is greater than men, yet men are more likely than women to undergo kidney replacement therapy, such as dialysis and kidney transplant. Additionally, women who do undergo dialysis have greater hospitalization rates, worse relative survival rates and an overall lower quality of life than men undergoing similar treatments.

In the study, researchers identified 227,847 people between 2009-2018 from the Stockholm Creatinine Measurements (SCREAM) project who presented with low levels of kidney function at their health checkups and were therefore suspected of having kidney disease. Approximately 55 percent or 126,289 of the subjects were women. The research team found that women were less likely to receive a diagnosis of chronic kidney disease or be referred to a nephrologist regardless of how severe their disease was as measured by the presence of albumin in the blood. In addition, women were less likely to have their creatine and albumin levels measured or given a referral to a nephrologist.

“We are unable to identify the reasons between this potential under-management, and speculate on possible causes, such as challenges in interpreting serum creatinine— a marker of kidney function and a waste product of the normal wear and tear on muscles of the body—in women who on average are smaller and have lower muscle mass than men,” said Oskar Swartling, MD, PhD student at the Karolinska Institute and lead author in the study. “It is also possible that subconscious biases operate among healthcare professionals, believing that CKD is less problematic in women, or that women themselves more likely deny their disease. In any case, our study brings attention to healthcare gaps amenable to correction.”

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