{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T20:59:51Z","timestamp":1780606791563,"version":"3.54.1"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100006005","name":"Agence de la BioM\u00e9decine","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100006005","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In patients with stage 4 and 5 chronic kidney disease (CKD), the reduction of kidney function prompts decisions regarding kidney replacement therapy (KRT): dialysis, transplantation or an alternative to KRT, ie conservative kidney management. The international literature reports that a majority of patients living with CKD (regardless of stage) are female, whilst more males undergo KRT. The objective of this study was to compare sex differences in terms of clinical trajectories and treatment decision making, taking into account clinico-biological characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A registry-based observational cohort study that included adult patients in Brittany, France enrolling CKD stages 4 and 5 between 2019 and 2021. Descriptive statistics were reported using frequencies and percentages, means and standard deviations. Variables included in the multivariate regression models (linear or logistic) were selected based on clinical relevance and statistical significance (P value &amp;lt;0.2 in univariate regression).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We included 1623 patients. At inclusion, 1048 patients (64%) had stage 4 CKD, including 627 males. Estimated GFR and age did not differ significantly between males and females. In terms of comorbidities, males had more cardiovascular disease (55% (n = 338)) than females (37% (n = 154), P &amp;lt; 0.001) and were more likely to have KRT planned than females (24% (n = 149) vs 16% (n = 65), P &amp;lt; 0.001). In multivariate logistic regression analysis, female sex was associated with a significantly lower probability of having a KRT plan, as well as a shorter duration of nephrology follow-up (less than one year), older age (&amp;gt;75 years), heart failure, living in a residential care facility or an institution, and having an underlying kidney disease defined as \u201cother\u201d, compared with chronic glomerulonephritis. The presence of a stable eGFR explained the majority of the \u201cnot discussed\u201d or \u201cundecided\u201d treatment plans for males and females (88% (n = 222) vs 90% (n = 306)).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study does not support the hypothesis that females with CKD are more likely to choose conservative kidney management than males, but it does suggest females are less likely to have a plan for KRT, which was in turn linked to stable kidney function in both sexes. The data showed no statistical difference in kidney function decline between females and males, however a larger study is needed to confirm this finding. Future research including other markers of kidney function decline could also help test this hypothesis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/joneph\/aajaf001","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T18:14:30Z","timestamp":1775067270000},"page":"88-98","source":"Crossref","is-referenced-by-count":1,"title":["Chronic kidney disease stage 4 and 5: comparison of therapeutic projects before kidney replacement therapy between men and women in Brittany"],"prefix":"10.1093","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5395-7488","authenticated-orcid":false,"given":"Pierre","family":"Gary-Bobo","sequence":"first","affiliation":[{"name":"Univ Rennes, EHESP, CNRS, Inserm, Ar\u00e8nes \u2013 UMR 6051, RSMS \u2013 U1309 , Rennes F-35000 ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5523-4160","authenticated-orcid":false,"given":"Sahar","family":"Bayat","sequence":"additional","affiliation":[{"name":"Univ Rennes, EHESP, CNRS, Inserm, Ar\u00e8nes \u2013 UMR 6051, RSMS \u2013 U1309 , Rennes F-35000 ,","place":["France"]},{"name":"Cellule r\u00e9gionale REIN Bretagne, centre hospitalo-universitaire Pontchaillou , 2, rue Henri-le-Guilloux, Rennes Cedex 9 35033 ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Naveiro","sequence":"additional","affiliation":[{"name":"Cellule r\u00e9gionale REIN Bretagne, centre hospitalo-universitaire Pontchaillou , 2, rue Henri-le-Guilloux, Rennes Cedex 9 35033 ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muriel","family":"Siebert","sequence":"additional","affiliation":[{"name":"Cellule r\u00e9gionale REIN Bretagne, centre hospitalo-universitaire Pontchaillou , 2, rue Henri-le-Guilloux, Rennes Cedex 9 35033 ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1619-2858","authenticated-orcid":false,"given":"Kathryn","family":"Ducharlet","sequence":"additional","affiliation":[{"name":"Eastern Health Clinical School, Monash University , Melbourne, Victoria ,","place":["Australia"]},{"name":"Eastern Health Integrated Renal Services, Eastern Health , Box Hill, Melbourne, Victoria ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1857-0656","authenticated-orcid":false,"given":"C\u00e9cile","family":"Vigneau","sequence":"additional","affiliation":[{"name":"Cellule r\u00e9gionale REIN Bretagne, centre hospitalo-universitaire Pontchaillou , 2, rue Henri-le-Guilloux, Rennes Cedex 9 35033 ,","place":["France"]},{"name":"Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Sant\u00e9, Environnement et Travail) \u2013 UMR_S 1085 , Rennes F-35000 ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,4,1]]},"reference":[{"key":"2026060416000852600_aajaf001-B1","author":"Haute Autorit\u00e9 de Sant\u00e9 [Internet]"},{"key":"2026060416000852600_aajaf001-B2","doi-asserted-by":"publisher","first-page":"S117","DOI":"10.1016\/j.kint.2023.10.018","article-title":"KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease","volume":"105","author":"Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group","year":"2024","journal-title":"Kidney Int."},{"key":"2026060416000852600_aajaf001-B3"},{"key":"2026060416000852600_aajaf001-B4","author":"Agence de la biom\u00e9decine"},{"key":"2026060416000852600_aajaf001-B5","doi-asserted-by":"publisher","first-page":"1178","DOI":"10.1038\/ki.2015.245","article-title":"Development of a risk stratification algorithm to improve patient-centered care and decision making for incident elderly patients with end-stage renal disease","volume":"88","author":"Couchoud","year":"2015","journal-title":"Kidney Int"},{"key":"2026060416000852600_aajaf001-B6","doi-asserted-by":"publisher","first-page":"633","DOI":"10.2215\/CJN.07510715","article-title":"Comparative survival among older adults with advanced kidney disease managed conservatively versus with dialysis","volume":"11","author":"Verberne","year":"2016","journal-title":"Clin J Am Soc Nephrol."},{"key":"2026060416000852600_aajaf001-B7","doi-asserted-by":"publisher","first-page":"1890","DOI":"10.34067\/KID.0001602022","article-title":"Quality of life in patients with chronic kidney disease managed with or without dialysis: an observational study","volume":"3","author":"So","year":"2022","journal-title":"Kidney360"},{"key":"2026060416000852600_aajaf001-B8","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1186\/s12882-017-0617-3","article-title":"Treatment decisions for older adults with advanced chronic kidney disease","volume":"18","author":"Rosansky","year":"2017","journal-title":"BMC Nephrol"},{"key":"2026060416000852600_aajaf001-B9","doi-asserted-by":"publisher","first-page":"7041","DOI":"10.3390\/jcm11237041","article-title":"Heart failure and cardiorenal syndrome: a narrative review on pathophysiology, diagnostic and therapeutic regimens-from a cardiologist's view","volume":"11","author":"Mitsas","year":"2022","journal-title":"J Clin Med"},{"key":"2026060416000852600_aajaf001-B10","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1681\/ASN.2018030296","article-title":"Sex-related disparities in CKD progression","volume":"30","author":"Ricardo","year":"2019","journal-title":"J Am Soc Nephrol"},{"key":"2026060416000852600_aajaf001-B11","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1038\/nrneph.2017.181","article-title":"Sex and gender disparities in the epidemiology and outcomes of chronic kidney disease","volume":"14","author":"Carrero","year":"2018","journal-title":"Nat Rev Nephrol. mars"},{"key":"2026060416000852600_aajaf001-B12","author":"Annual Reports [Internet]"},{"key":"2026060416000852600_aajaf001-B13","doi-asserted-by":"publisher","first-page":"2086","DOI":"10.1093\/ndt\/gfw354","article-title":"Prevalence and recognition of chronic kidney disease in Stockholm healthcare","volume":"31","author":"Gasparini","year":"2016","journal-title":"Nephrol Dial Transplant"},{"key":"2026060416000852600_aajaf001-B14","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1016\/j.nephro.2018.11.010","article-title":"Vers une extension du registre REIN aux patients avec une maladie r\u00e9nale chronique au stade 5 non trait\u00e9s par dialyse ou greffe? \u00c9tude pilote","volume":"15","author":"Vigneau","year":"2019","journal-title":"N\u00e9phrologie Th\u00e9rapeutique"},{"key":"2026060416000852600_aajaf001-B15","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1093\/ndt\/gfy058","article-title":"Risk profile, quality of life and care of patients with moderate and advanced CKD: the French CKD-REIN Cohort Study","volume":"34","author":"Stengel","year":"2019","journal-title":"Nephrol Dial Transplant"},{"key":"2026060416000852600_aajaf001-B16","doi-asserted-by":"publisher","first-page":"190","DOI":"10.1053\/j.ajkd.2020.11.026","article-title":"CKD progression and mortality among men and women: a nationwide study in Sweden","volume":"78","author":"Swartling","year":"2021","journal-title":"Am J Kidney Dis"},{"key":"2026060416000852600_aajaf001-B17","doi-asserted-by":"publisher","first-page":"796","DOI":"10.1016\/j.ekir.2020.12.015","article-title":"Population estimates of GFR and risk factors for CKD in Guatemala","volume":"6","author":"Miller","year":"2021","journal-title":"Kidney Int Rep"},{"key":"2026060416000852600_aajaf001-B18","doi-asserted-by":"publisher","first-page":"704","DOI":"10.1016\/S2213-8587(15)00128-X","article-title":"Age and association of body mass index with loss of kidney function and mortality","volume":"3","author":"Lu","year":"2015","journal-title":"Lancet Diabetes Endocrinol"},{"key":"2026060416000852600_aajaf001-B19","doi-asserted-by":"publisher","first-page":"100447","DOI":"10.1016\/j.xkme.2022.100447","article-title":"Survival of older patients with advanced CKD managed without dialysis: a narrative review","volume":"4","author":"Chou","year":"2022","journal-title":"Kidney Med"},{"key":"2026060416000852600_aajaf001-B20","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1111\/nep.12586","article-title":"Survival outcomes of supportive care versus dialysis therapies for elderly patients with end-stage kidney disease: a systematic review and meta-analysis","volume":"21","author":"Foote","year":"2016","journal-title":"Nephrol Carlton Vic"},{"key":"2026060416000852600_aajaf001-B21","doi-asserted-by":"publisher","first-page":"648","DOI":"10.2215\/CJN.07830520","article-title":"Risk factors for CKD progression: overview of findings from the CRIC study","volume":"16","author":"Hannan","year":"2021","journal-title":"Clin J Am Soc Nephrol."},{"key":"2026060416000852600_aajaf001-B22","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1053\/j.ajkd.2017.01.050","article-title":"Risks of adverse events in advanced CKD: the chronic renal insufficiency cohort (CRIC) study","volume":"70","author":"Grams","year":"2017","journal-title":"Am J Kidney Dis Off J Natl Kidney Found"},{"key":"2026060416000852600_aajaf001-B23","doi-asserted-by":"publisher","first-page":"e0130080","DOI":"10.1371\/journal.pone.0130080","article-title":"Factors associated with unplanned dialysis starts in patients followed by nephrologists: a retropective cohort study","volume":"10","author":"Brown","year":"2015","journal-title":"PLoS One"},{"key":"2026060416000852600_aajaf001-B24","doi-asserted-by":"publisher","first-page":"657","DOI":"10.1053\/j.ajkd.2021.08.021","article-title":"Challenges to shared decision making about treatment of advanced CKD: a qualitative study of patients and clinicians","volume":"79","author":"House","year":"2022","journal-title":"Am J Kidney Dis"},{"key":"2026060416000852600_aajaf001-B25","doi-asserted-by":"publisher","first-page":"532","DOI":"10.1016\/j.xkme.2020.05.008","article-title":"Advanced CKD care and decision making: which health care professionals do patients rely on for CKD treatment and advice?","volume":"2","author":"Barrett","year":"2020","journal-title":"Kidney Med"},{"key":"2026060416000852600_aajaf001-B26","doi-asserted-by":"publisher","first-page":"1903","DOI":"10.1681\/ASN.2022030373","article-title":"Sex differences in the recognition, monitoring, and management of CKD in health care: an observational cohort study","volume":"33","author":"Swartling","year":"2022","journal-title":"J Am Soc Nephrol."},{"key":"2026060416000852600_aajaf001-B27","doi-asserted-by":"publisher","first-page":"e0279291","DOI":"10.1371\/journal.pone.0279291","article-title":"An exploration of under-registration of chronic kidney disease stages 3-5 in Belgian general practices using logistic regression","volume":"17","author":"Van den Wyngaert","year":"2022","journal-title":"PLoS One"},{"key":"2026060416000852600_aajaf001-B28","doi-asserted-by":"publisher","first-page":"468","DOI":"10.37765\/ajmc.2020.88526","article-title":"Primary care referrals to nephrology in patients with advanced kidney disease","volume":"26","author":"Dharod","year":"2020","journal-title":"Am J Manag Care"},{"key":"2026060416000852600_aajaf001-B29","doi-asserted-by":"publisher","first-page":"20406223221108396","DOI":"10.1177\/20406223221108397","article-title":"The dynamics of the general practitioner-nephrologist collaboration for the management of patients with chronic kidney disease before and after dialysis initiation: a mixed-methods study","volume":"13","author":"Raffray","year":"2022","journal-title":"Ther Adv Chronic Dis"},{"key":"2026060416000852600_aajaf001-B30","doi-asserted-by":"publisher","first-page":"653","DOI":"10.1053\/j.ajkd.2018.02.364","article-title":"Risk of progression of nonalbuminuric CKD to end-stage kidney disease in people with diabetes: the CRIC (Chronic Renal Insufficiency Cohort) study","volume":"72","author":"Koye","year":"2018","journal-title":"Am J Kidney Dis Off J Natl Kidney Found"}],"container-title":["Journal of Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/joneph\/article-pdf\/39\/1\/88\/67716041\/aajaf001.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/joneph\/article-pdf\/39\/1\/88\/67716041\/aajaf001.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T20:00:15Z","timestamp":1780603215000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/joneph\/article\/39\/1\/88\/8571456"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":30,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,4,1]]},"published-print":{"date-parts":[[2026,6,4]]}},"URL":"https:\/\/doi.org\/10.1093\/joneph\/aajaf001","relation":{},"ISSN":["1121-8428","1724-6059"],"issn-type":[{"value":"1121-8428","type":"print"},{"value":"1724-6059","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,1]]},"published":{"date-parts":[[2026,1]]}}}