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. 2025 Feb 24;18(3):sfaf046.
doi: 10.1093/ckj/sfaf046. eCollection 2025 Mar.

The 60:40 conundrum: are women with CKD discriminated after referral to a nephrology clinic?

Adele Vautcranne  1 , Lavinia Bianco  1 , Béatrice Mazé  1 , Antioco Fois  1 , Antoine Chatrenet  1 , Maria Rita Moio  1 , Gulia Santagati  1 , Linda Njandjo  1 , Pierre-Yves de Müllenheim  2 , Massimo Torreggiani  1 , Giorgina Barbara Piccoli  1
Affiliations

The 60:40 conundrum: are women with CKD discriminated after referral to a nephrology clinic?

Adele Vautcranne et al. Clin Kidney J. .

Abstract

Background: Epidemiological data show that chronic kidney disease (CKD) is more prevalent among females than males but the prevalence of women in dialysis is lower, as is their representation in nephrology trials. We aimed to test whether sex distribution varies at nephrology referral, inclusion in a trial, or at the starting of dialysis.

Methods: We evaluated patients' characteristics at the time of the first consultation in the Unit for the Care of Advanced CKD (UIRAV), at the inclusion in an observational study (PRO-RE-RE-PRO) and at the beginning of dialysis. Patient and renal survival analysis was performed in the pre-dialysis phase and after dialysis start. Reasons for denying participation to the proposed study and causes of death or withdrawal from follow-up and dialysis were likewise examined.

Results: During the period 2017-2023, 866 patients were referred to the UIRAV, 59% males and 41% females. Female patients were older, had lower comorbidity and were referred at the same eGFR than males. The same male/female proportion was observed in patients included in the PRO-RE-RE-PRO study and at dialysis start. Survival was significantly higher in females. Overall, distribution across sex remained stable over time.

Conclusions: Males and females are referred at similar eGFR levels, which appears to be the main reason for seeking nephrology care. Afterward, the ratio between males and females remains stable, suggesting that if a sex-selection bias exists, it should be sought before the first nephrology referral. However, further studies are needed to ensure that health equity is respected across sexes.

Keywords: dialysis; gender medicine; recruitment in studies; referral; selection.

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Conflict of interest statement

None declared.

Figures

Figure 1:
Figure 1:
Flow chart of patients from referral to inclusion in the PRO-RE-RE-PRO study.
Figure 2:
Figure 2:
(a) UIRAV patient survival according to sex. (b) UIRAV patient survival according to sex and CCI (dichotomized at 7). (c) Persistence in the system (outcome death or dialysis start).
See this image and copyright information in PMC

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