Keywords: "Chronic Kidney Disease" "Sex" "Costs" "Economic evaluation"

Background:

Chronic kidney disease (CKD) is a growing global health problem, especially in aging populations. Sex influences various aspects of CKD aetiology, diagnosis, and management, but its impact on healthcare resource use and costs remains unclear.

Research questions:

This study aims to explore sex-based differences in healthcare costs related to incident CKD in primary care, according to KDIGO risk and cardio-renal-metabolic comorbidities (CRMC).

Method:

We conducted a retrospective cohort study using electronic health records from the SIDIAP database (2012–2021), covering ~75% of the Catalan population. Adults with incident CKD were included based on diagnostic codes or persistent renal parameters (eGFR <60 ml/min/1.73m² or ACR ≥30 mg/g for ≥90 days). Costs (hospitalizations, visits, drugs, tests, referrals, sick leave and kidney replacement therapy -KRT-) were calculated per person-years from CKD onset until end of follow-up and stratified per KDIGO risk and CRMC (T2D and/or HF). Cost ratios (CR) were estimated dividing costs for men by costs for women.

Results:

Among 428,434 incident CKD patients (54.03% women), hospitalizations accounted for 61.2% of costs. Men incurred higher economic burden in hospitalization costs (CR ranging from 1.18 in T2D, HF and very high KDIGO risk patients to 1.40 in patients with very high risk and no CRMC), sick leave (from 1.61 to -in T2D, HF and very high KDIGO risk-18.95), KRT (1.09 - 4.68), drugs (1.12–2.00), tests (1.08-1.37), and referrals (1.01-1.48). Visit-related costs varied from 0.93 in patients with T2D and moderate KDIGO risk, to 1.07 in patients with HF and very high risk.

Conclusions:

Sex differences exist in the economic impact of CKD follow-up, with men generally generating higher costs. Despite concerns about underdiagnosis and undermanagement in women, this did not translate into greater resource use within comorbidity- and risk-matched groups. The observed differences may relate to underlying renal disease differences and prognosis in women and men.

Points for discussion:

Should CKD follow-up strategies in primary care be sex-specific?

Could current CKD risk stratification tools be sex-biased?

How do biological and sociocultural gender factors influence CKD management?