Sex Differences in Primary Care–Based Chronic Kidney Disease Management

Rodriguez, Jorge A.; Chen, Sarah W.; Gao, Chenxi; Lipsitz, Stuart R.; Mendu, Mallika L.; Samal, Lipika

doi:10.1001/jama.2024.8914

JAMA

2024

DOI: 10.1001/jama.2024.8914

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Sex Differences in Primary Care–Based Chronic Kidney Disease Management

Jorge A. Rodriguez,

Sarah W. Chen,

Chenxi Gao

et al.

Abstract: This retrospective study uses electronic health record data to investigate the sex differences in guideline-based management outcomes between male and female patients with chronic kidney disease.

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2024

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Primary Care–Based Chronic Kidney Disease Management

2024

JAMA

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To the Editor Although the study by Dr Rodriguez and colleagues 1 provides a solid foundation for understanding gender differences in chronic kidney disease (CKD) management, several issues merit further discussion to enhance the study's contributions to this critical area of health care.First, we would be grateful if the authors could clarify whether the female patient cohort included pregnant individuals, as pregnancy impacts CKD management and outcomes. 2 Pregnancy introduces unique physiological changes that can exacerbate CKD, such as increased glomerular filtration rate and proteinuria, alongside heightened risks of hypertension. 3 Therefore, the potential inclusion of pregnant individuals in the analysis without appropriate adjustments could confound the results, overstating or understating the gender differences observed. It would be beneficial if the authors included pregnancy as a variable in their statistical models.Stratifying the data to separately analyze pregnant and nonpregnant individuals could provide clearer insights into how pregnancy influences CKD management and outcomes.Second, the potential influence of clinician gender and specific training in CKD management is another area that de-serves attention. Evidence suggests that women clinicians may exhibit different communication styles, empathy levels, and adherence to clinical guidelines, 4 which can affect patient satisfaction and outcomes in CKD.

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Primary Care–Based Chronic Kidney Disease Management

2024

JAMA

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Primary Care–Based Chronic Kidney Disease Management—Reply

Rodriguez,

Gao,

Samal

2024

JAMA

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COMMENT & RESPONSEIn Reply We appreciate the letter from Dr Hu regarding additional points of consideration for our study on CKD. 1 We agree that it is critical to consider pregnancy in studies assessing sex disparities in health care. For our study, females of reproductive age accounted for only 0.8% of our cohort (n = 35). We did not expect this small number of patients to change our results, so we did not plan a subgroup analysis. However, the care of patients before, during, and after pregnancy highlights opportunities for future research. For example, although angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are contraindicated in pregnancy, the resumption of guideline-concordant medications after pregnancy is necessary to prevent exacerbation of existing disparities. Similarly, future analyses of CKD care stratified by race and ethnicity during pregnancy and the postpartum period will be important and may shed light on disparities in gestational hypertension, postpartum hypertension, and long-term cardiovascular outcomes. 2,3 It is interesting to consider how primary care practitioner (PCP) gender and training impact CKD management. Although differences in training can be overcome by continuing medical education, it is less clear how differences by PCP gender would be addressed. This is an area that warrants further research. When thinking about gender and CKD management, it is important to consider the care processes that impact PCPs. Prior work has explored this issue in the context of clinician burnout, since female clinicians experience higher levels of burnout than male clinicians. 4 Research by our colleagues has shown that, compared with male PCPs, female PCPs have higher electronic health record (EHR) inbox workload and spend more time on EHRs overall, including after hours and on EHR-based documentation. 5,6 Ultimately, addressing sex disparities in CKD care will require multifaceted interventions that account for both patient and clinician factors while prioritizing health equity.

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Advancing gender equity to improve kidney care for women: a patient perspective

Conklin,

Ahmed

2024

Nat Rev Nephrol

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Sex Differences in Primary Care–Based Chronic Kidney Disease Management

Abstract: This retrospective study uses electronic health record data to investigate the sex differences in guideline-based management outcomes between male and female patients with chronic kidney disease.

Cited by 4 publications

References 6 publications

Primary Care–Based Chronic Kidney Disease Management

Primary Care–Based Chronic Kidney Disease Management

Primary Care–Based Chronic Kidney Disease Management—Reply

Advancing gender equity to improve kidney care for women: a patient perspective

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