Reported sex differences in the etiology, population prevalence, progression rates, and health outcomes of people with CKD may be explained by differences in health care.

We evaluated sex as the variable of interest in a health care–based study of adults (n=227,847) with at least one outpatient eGFR<60 ml/min per 1.73 m² measurement denoting probable CKD in Stockholm from 2009 to 2017. We calculated the odds ratios for diagnosis of CKD and provision of RASi and statins at inclusion, and hazard ratios for CKD diagnosis, visiting a nephrologist, or monitoring creatinine and albuminuria during follow-up.

We identified 227,847 subjects, of whom 126,289 were women (55%). At inclusion, women had lower odds of having received a diagnostic code for CKD and were less likely to have received RASi and statins, despite having guideline-recommended indications. In time-to-event analyses, women were less likely to have received a CKD diagnosis (HR, 0.43; 95% CI, 0.42 to 0.45) and visited a nephrologist (HR, 0.46; 95% CI, 0.43 to 0.48) regardless of disease severity, presence of albuminuria, or criteria for referral. Women were also less likely to undergo monitoring of creatinine or albuminuria, including those with diabetes or hypertension. These differences remained after adjustment for comorbidities, albuminuria, and highest educational achievement, and among subjects with confirmed CKD at retesting. Although in absolute terms all nephrology-care indicators gradually improved over time, the observed sex gap persisted.

There were profound sex differences in the detection, recognition, monitoring, referrals, and management of CKD. The disparity was also observed in people at high risk and among those who had guideline-recommended indications.

所报道的 CKD 患者在病因学、人群患病率、进展率和健康结果方面的性别差异可能是由医疗保健的差异来解释的。

我们在一项基于医疗保健的成人研究中将性别作为感兴趣的变量进行了评估（n = 227,847） ，2009 年至 2017 年斯德哥尔摩至少有一名门诊患者每 1.73 m ²测量值 eGFR<60 ml/min，表示可能患有 CKD。我们计算诊断 CKD 并在纳入时提供 RASi 和他汀类药物的比值比，以及 CKD 诊断、拜访肾病专家或在随访期间监测肌酐和蛋白尿的风险比。

我们确定了 227,847 名受试者，其中 126,289 名是女性（55%）。纳入时，女性获得 CKD 诊断代码的几率较低，并且接受 RASi 和他汀类药物的可能性较小，尽管有指南推荐的适应症。在事件发生时间分析中，女性不太可能被诊断为 CKD（HR，0.43；95% CI，0.42 至 0.45）并去看肾科医生（HR，0.46；95% CI，0.43 至 0.48），无论其情况如何。疾病严重程度、蛋白尿的存在或转诊标准。女性也不太可能接受肌酐或蛋白尿监测，包括患有糖尿病或高血压的女性。在对合并症、蛋白尿和最高教育成绩进行调整后，以及在重新测试时确诊为 CKD 的受试者中，这些差异仍然存在。尽管从绝对值来看，所有肾病护理指标随着时间的推移逐渐改善，但观察到的性别差距仍然存在。

在 CKD 的检测、识别、监测、转诊和管理方面存在显着的性别差异。在高危人群和具有指南推荐适应症的人群中也观察到了这种差异。