{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T05:30:41Z","timestamp":1793856641481,"version":"4.6.1"},"reference-count":47,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","funder":[{"DOI":"10.13039\/501100004359","name":"Swedish Research Council","doi-asserted-by":"publisher","award":["2019-01059"],"award-info":[{"award-number":["2019-01059"]}],"id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["JASN"],"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We evaluated sex as the variable of interest in a health care\u2013based study of adults (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      =227,847) with at least one outpatient eGFR&lt;60 ml\/min per 1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Podcast<\/jats:title>\n                    <jats:p>This article contains a podcast at https:\/\/www.asn-online.org\/media\/podcast\/JASN\/2022_10_11_JASN2022030373.mp3.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1681\/asn.2022030373","type":"journal-article","created":{"date-parts":[[2022,7,29]],"date-time":"2022-07-29T14:55:14Z","timestamp":1659106514000},"page":"1903-1914","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":102,"title":["Sex Differences in the Recognition, Monitoring, and Management of CKD in Health Care: An Observational Cohort Study"],"prefix":"10.1681","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3783-1567","authenticated-orcid":false,"given":"Oskar","family":"Swartling","sequence":"first","affiliation":[{"name":"Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanhang","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4538-5958","authenticated-orcid":false,"given":"Catherine M.","family":"Clase","sequence":"additional","affiliation":[{"name":"Departments of Medicine and Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9698-6825","authenticated-orcid":false,"given":"Edouard L.","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"},{"name":"Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8047-2395","authenticated-orcid":false,"given":"Manfred","family":"Hecking","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"H\u00f6dlmoser","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria"},{"name":"Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ylva","family":"Trolle-Lagerros","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden"},{"name":"Center for Obesity, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"Evans","sequence":"additional","affiliation":[{"name":"Department of Clinical Intervention and Technology, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan J.","family":"Carrero","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"},{"name":"Division of Nephrology, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2022,10]]},"reference":[{"key":"B2-20250823","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1016\/S0140-6736(20)30045-3","article-title":"Global, regional, and national burden of chronic kidney disease, 1990\u20132017: A systematic analysis for the Global Burden of Disease Study 2017","volume":"395","year":"2020","journal-title":"Lancet"},{"key":"B3-20250823","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1053\/j.ajkd.2015.11.005","article-title":"CKD and health-related quality of life: The Korea national health and nutrition examination survey","volume":"67","author":"Park","year":"2016","journal-title":"Am J Kidney Dis"},{"key":"B4-20250823","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1053\/j.ajkd.2019.08.026","article-title":"Perceived health and quality of life in patients with CKD, including those with kidney failure: Findings from national surveys in France","volume":"75","author":"Legrand","year":"2020","journal-title":"Am J Kidney Dis"},{"key":"B5-20250823","doi-asserted-by":"crossref","first-page":"1110","DOI":"10.1111\/ijcp.12454","article-title":"Prevalence and management of chronic kidney disease in primary care patients in the UK","volume":"68","author":"Jameson","year":"2014","journal-title":"Int J Clin Pract"},{"key":"B6-20250823","doi-asserted-by":"crossref","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"},{"key":"B7-20250823","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1053\/j.ajkd.2013.03.009","article-title":"Lifetime incidence of CKD stages 3-5 in the United States","volume":"62","author":"Grams","year":"2013","journal-title":"Am J Kidney Dis"},{"key":"B8-20250823","doi-asserted-by":"crossref","first-page":"1569","DOI":"10.1681\/ASN.2012020164","article-title":"Lifetime risk of ESRD","volume":"23","author":"Turin","year":"2012","journal-title":"J Am Soc Nephrol"},{"key":"B9-20250823","doi-asserted-by":"crossref","first-page":"e1001750","DOI":"10.1371\/journal.pmed.1001750","article-title":"Sex-specific differences in hemodialysis prevalence and practices and the male-to-female mortality rate: The Dialysis Outcomes and Practice Patterns Study (DOPPS)","volume":"11","author":"Hecking","year":"2014","journal-title":"PLoS Med"},{"key":"B10-20250823","doi-asserted-by":"crossref","first-page":"1616","DOI":"10.2215\/CJN.04400419","article-title":"Sex differences in kidney replacement therapy initiation and maintenance","volume":"14","author":"Antlanger","year":"2019","journal-title":"Clin J Am Soc Nephrol"},{"key":"B11-20250823","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1053\/j.ajkd.2019.05.019","article-title":"Sex differences in the progression of CKD among older patients: Pooled analysis of 4 cohort studies","volume":"75","author":"Minutolo","year":"2020","journal-title":"Am J Kidney Dis"},{"key":"B12-20250823","doi-asserted-by":"crossref","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":"B13-20250823","doi-asserted-by":"crossref","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":"B14-20250823","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1053\/j.ajkd.2011.08.024","article-title":"Patients who plan for conservative care rather than dialysis: A national observational study in Australia","volume":"59","author":"Morton","year":"2012","journal-title":"Am J Kidney Dis"},{"key":"B15-20250823","doi-asserted-by":"crossref","first-page":"1557","DOI":"10.2215\/CJN.11030919","article-title":"Sex and the incidence and prevalence of kidney disease","volume":"14","author":"Tomlinson","year":"2019","journal-title":"Clin J Am Soc Nephrol"},{"key":"B16-20250823","doi-asserted-by":"crossref","first-page":"2721","DOI":"10.1681\/ASN.2016090986","article-title":"Sex differences in hospitalizations with maintenance hemodialysis","volume":"28","author":"Adams","year":"2017","journal-title":"J Am Soc Nephrol"},{"key":"B17-20250823","doi-asserted-by":"crossref","first-page":"1402","DOI":"10.2215\/CJN.12621213","article-title":"Race\/ethnicity, age, and risk of hospital admission and length of stay during the first year of maintenance hemodialysis","volume":"9","author":"Yan","year":"2014","journal-title":"Clin J Am Soc Nephrol"},{"key":"B18-20250823","doi-asserted-by":"crossref","first-page":"e068247","DOI":"10.1136\/BMJ-2021-068247","article-title":"Sex differences in mortality among binational cohort of people with chronic kidney disease: Population based data linkage study","volume":"375","author":"De La Mata","year":"2021","journal-title":"BMJ"},{"key":"B19-20250823","doi-asserted-by":"crossref","first-page":"e364","DOI":"10.1161\/STR.0000000000000375","article-title":"2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack: A guideline from the American Heart Association\/American Stroke Association","volume":"52","author":"Kleindorfer","year":"2021","journal-title":"Stroke"},{"issue":"Suppl 1","key":"B20-20250823","first-page":"S34","article-title":"3. Prevention or delay of type 2 diabetes: Standards of medical care in diabetes-2021","volume":"44","year":"2021","journal-title":"Diabetes Care"},{"key":"B21-20250823","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1053\/j.ajkd.2003.12.046","article-title":"Unreferred chronic kidney disease: A longitudinal study","volume":"43","author":"John","year":"2004","journal-title":"Am J Kidney Dis"},{"key":"B22-20250823","doi-asserted-by":"crossref","first-page":"1373","DOI":"10.1093\/ndt\/gfx280","article-title":"How do primary care doctors in England and Wales code and manage people with chronic kidney disease? Results from the National Chronic Kidney Disease Audit","volume":"33","author":"Kim","year":"2018","journal-title":"Nephrol Dial Transplant"},{"key":"B23-20250823","doi-asserted-by":"crossref","first-page":"e1910704","DOI":"10.1001\/jamanetworkopen.2019.10704","article-title":"Quality of chronic kidney disease management in Canadian primary care","volume":"2","author":"Bello","year":"2019","journal-title":"JAMA Netw Open"},{"key":"B24-20250823","doi-asserted-by":"crossref","first-page":"e0243431","DOI":"10.1371\/journal.pone.0243431","article-title":"Sex differences in chronic kidney disease awareness among US adults, 1999 to 2018","volume":"15","author":"H\u00f6dlmoser","year":"2020","journal-title":"PLoS One"},{"key":"B25-20250823","doi-asserted-by":"crossref","first-page":"1762","DOI":"10.1161\/HYPERTENSIONAHA.120.15956","article-title":"Association of albuminuria levels with the prescription of renin-angiotensin system blockade","volume":"76","author":"Qiao","year":"2020","journal-title":"Hypertension"},{"key":"B26-20250823","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1111\/joim.13418","article-title":"The Stockholm CREAtinine Measurements (SCREAM) project: Fostering improvements in chronic kidney disease care","volume":"291","author":"Carrero","year":"2022","journal-title":"J Intern Med"},{"key":"B27-20250823","doi-asserted-by":"crossref","first-page":"604","DOI":"10.7326\/0003-4819-150-9-200905050-00006","article-title":"A new equation to estimate glomerular filtration rate","volume":"150","author":"Levey","year":"2009","journal-title":"Ann Intern Med"},{"key":"B29-20250823","doi-asserted-by":"crossref","first-page":"533","DOI":"10.2147\/CLEP.S314959","article-title":"Nordic health registry-based research: A review of health care systems and key registries","volume":"13","author":"Laugesen","year":"2021","journal-title":"Clin Epidemiol"},{"key":"B30-20250823","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1007\/s10654-019-00511-8","article-title":"The longitudinal integrated database for health insurance and labour market studies (LISA) and its use in medical research","volume":"34","author":"Ludvigsson","year":"2019","journal-title":"Eur J Epidemiol"},{"key":"B31-20250823","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1515\/cclm-2013-0741","article-title":"The revised Lund-Malm\u00f6 GFR estimating equation outperforms MDRD and CKD-EPI across GFR, age and BMI intervals in a large Swedish population","volume":"52","author":"Nyman","year":"2014","journal-title":"Clin Chem Lab Med"},{"key":"B32-20250823","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/s12875-015-0235-8","article-title":"Timeliness in chronic kidney disease and albuminuria identification: A retrospective cohort study","volume":"16","author":"Fraser","year":"2015","journal-title":"BMC Fam Pract"},{"key":"B33-20250823","doi-asserted-by":"crossref","first-page":"727","DOI":"10.2215\/CJN.08720816","article-title":"A population-based analysis of quality indicators in CKD","volume":"12","author":"Manns","year":"2017","journal-title":"Clin J Am Soc Nephrol"},{"key":"B34-20250823","doi-asserted-by":"crossref","first-page":"2439","DOI":"10.1681\/ASN.2005020192","article-title":"Low rates of testing and diagnostic codes usage in a commercial clinical laboratory: Evidence for lack of physician awareness of chronic kidney disease","volume":"16","author":"Stevens","year":"2005","journal-title":"J Am Soc Nephrol"},{"key":"B35-20250823","doi-asserted-by":"crossref","first-page":"1299","DOI":"10.1681\/ASN.2006050524","article-title":"Longitudinal study of racial and ethnic differences in developing end-stage renal disease among aged Medicare beneficiaries","volume":"18","author":"Xue","year":"2007","journal-title":"J Am Soc Nephrol"},{"key":"B36-20250823","doi-asserted-by":"crossref","first-page":"2351","DOI":"10.1681\/ASN.V11122351","article-title":"Late initiation of dialysis among women and ethnic minorities in the United States","volume":"11","author":"Kausz","year":"2000","journal-title":"J Am Soc Nephrol"},{"key":"B37-20250823","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1093\/ckj\/sfab210","article-title":"Use of nephrotoxic medications in adults with chronic kidney disease in Swedish and US routine care","volume":"15","author":"Bosi","year":"2021","journal-title":"Clin Kidney J"},{"key":"B38-20250823","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/j.ekir.2019.12.003","article-title":"Preventing CKD in developed countries","volume":"5","author":"Luyckx","year":"2019","journal-title":"Kidney Int Rep"},{"key":"B39-20250823","doi-asserted-by":"crossref","first-page":"298","DOI":"10.7326\/0003-4819-137-4-200208200-00026","article-title":"Effect of angiotensin-converting enzyme inhibitors on progression of nondiabetic renal disease","volume":"137","author":"Jafar","year":"2002","journal-title":"Ann Intern Med"},{"key":"B40-20250823","doi-asserted-by":"crossref","first-page":"1456","DOI":"10.1056\/NEJM199311113292004","article-title":"The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy","volume":"329","author":"Lewis","year":"1993","journal-title":"N Engl J Med"},{"key":"B41-20250823","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1161\/CIRCULATIONAHA.113.005081","article-title":"Renal hemodynamic effect of sodium-glucose cotransporter 2 inhibition in patients with type 1 diabetes mellitus","volume":"129","author":"Cherney","year":"2014","journal-title":"Circulation"},{"key":"B42-20250823","doi-asserted-by":"crossref","first-page":"73","DOI":"10.7326\/0003-4819-135-2-200107170-00007","article-title":"Angiotensin-converting enzyme inhibitors and progression of nondiabetic renal disease. A meta-analysis of patient-level data","volume":"135","author":"Jafar","year":"2001","journal-title":"Ann Intern Med"},{"key":"B43-20250823","doi-asserted-by":"crossref","first-page":"1547","DOI":"10.1056\/NEJMoa0801317","article-title":"Telmisartan, ramipril, or both in patients at high risk for vascular events","volume":"358","author":"Yusuf","year":"2008","journal-title":"N Engl J Med"},{"key":"B44-20250823","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1016\/j.ahj.2010.08.012","article-title":"Study of Heart and Renal Protection (SHARP): Randomized trial to assess the effects of lowering low-density lipoprotein cholesterol among 9,438 patients with chronic kidney disease","volume":"160","year":"2010","journal-title":"Am Heart J"},{"key":"B45-20250823","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1001\/archinte.163.3.356","article-title":"Serum creatinine is an inadequate screening test for renal failure in elderly patients","volume":"163","author":"Swedko","year":"2003","journal-title":"Arch Intern Med"},{"key":"B46-20250823","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1053\/j.ajkd.2014.02.023","article-title":"Impact of estimated GFR reporting on late referral rates and practice patterns for end-stage kidney disease patients: A multilevel logistic regression analysis using the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA)","volume":"64","author":"Foote","year":"2014","journal-title":"Am J Kidney Dis"},{"issue":"6","key":"B47-20250823","first-page":"CD007333","article-title":"Early referral to specialist nephrology services for preventing the progression to end-stage kidney disease","author":"Smart","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"key":"B48-20250823","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1016\/j.ekir.2021.11.018","article-title":"Sex-specific differences in mortality and incident dialysis in the chronic kidney disease outcomes and practice patterns study","volume":"7","author":"Hecking","year":"2021","journal-title":"Kidney Int Rep"},{"key":"B49-20250823","doi-asserted-by":"crossref","first-page":"207","DOI":"10.4321\/S1886-36552012000400005","article-title":"Women and men report different behaviours in, and reasons for medication non-adherence: A nationwide Swedish survey","volume":"10","author":"Thunander Sundbom","year":"2012","journal-title":"Pharm Pract (Granada)"}],"container-title":["Journal of the American Society of Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.1681\/ASN.2022030373","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T19:49:14Z","timestamp":1786132154000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1681\/ASN.2022030373"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10]]},"references-count":47,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2022]]}},"URL":"https:\/\/doi.org\/10.1681\/asn.2022030373","relation":{},"ISSN":["1046-6673","1533-3450"],"issn-type":[{"value":"1046-6673","type":"print"},{"value":"1533-3450","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10]]},"assertion":[{"value":"2022-03-28","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-06-09","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}