Research Award Recipients

Sex and gender differences in the burden, management, and outcomes of chronic kidney disease

Co-Applicant(s): Aminu Bello, Dale Birdsell, Matthew James, Meghan Elliott, Neesh Pannu, Paul Ronksley, Pietro Ravani, Sandra Dumanski, Shannon Ruzycki, Simon Sawhney, Sofia Ahmed, Tyrone Harrison, Yang Liu

Lay Abstract

Background: Some studies have shown that while early stages of chronic kidney disease (CKD) are more common in males or men, females or women are more likely to develop advanced CKD. However, more males or men receive dialysis treatment or kidney transplants for kidney failure. This contradiction may be due to a mix of biological sex and sociocultural gender factors, such as differences in access to health services, treatment, or related health conditions. However, existing studies have limitations, including the use of suboptimal methods to define CKD and insufficient duration to observe what happens to people over time. For example, individuals’ representation in a CKD stage may depend on how often each person enters that stage, how long they remain there, and how quickly they leave that stage, because their CKD improves or worsens, or they die. One way to better understand sex/gender differences in the burden of CKD is to examine its burden and outcomes across different stages of the disease. For example, kidney function may decline more slowly in females or women, yet kidney function may be more likely to improve in males or men, especially in less severe CKD stages.

Purpose: To identify potential sex/gender-based differences in the incidence (new cases of CKD over a period of time), prevalence (existing cases at a given time or over a period of time), management, and outcomes of CKD stages G1-5.

Methods: This project will use world-class health data sources, routinely recorded over decades in Alberta to capture the natural history of CKD. We will follow guideline recommendations to identify new cases of CKD and assess outcomes of CKD improvement and progression, which will enable more accurate estimates of the CKD burden. We will calculate the rates at which males, females, and transgender or non-binary individuals enter or leave different stages of CKD. We will examine sex/gender differences in CKD stage at the first CKD documentation and outcomes over time, including CKD regression and progression. We will also study disease management following CKD diagnosis by sex and gender, including access to health services, use of recommended medications that protect the kidneys, and avoidance of kidney-damaging medications.

Anticipated Outcomes: The project will provide novel, comprehensive data on the burden of CKD, and identify factors contributing to sex/gender differences in disease outcomes. The results will inform data-driven recommendations for more effective CKD monitoring and management.

Patient Engagement: Two persons with different sexes and genders living with CKD have helped us create this research plan and will stay involved throughout this project.

Relevance to Patients/Community: This research program is designed to identify potential inequities in kidney health outcomes by sex and gender. If we identify sub-optimal treatment of comorbid conditions associated with worse CKD outcomes in females or women experiencing social or economic challenges, delays in the identification of CKD in males or men with specific risk factors, or worse CKD outcomes in transgender and non-binary individuals, these findings will guide the development of programs to improve testing, medication use, and adherence, ultimately improving care for those at higher risk of CKD and adverse CKD outcomes.

Conclusion: This research will help develop better monitoring and treatment strategies tailored to adult persons affected by CKD, improving kidney health outcomes and equity.