HANNAH WALLACE1,2,3, LUKE BUIZEN1, PROF SUNIL V BADVE1, DR JEEFERY T HA1, DANIEL BEKELE KETEMA1, A/PROF PAUL RONKSLEY4, DR TAKAYA SASAKI1, DR KATIE HARRIS1, PROF AMANDA HENRY1,5, PROF MARK WOODWARD1,6, PROF SRADHA S KOTWAL1, A/PROF MIN JUN1,5
1The George Institute for Global Health, Sydney, Australia, 2Western Health Chronic Disease Alliance, Western Health, Australia , 3Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia, 4Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada, 5Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia, 6The George Institute for Global Health, Imperial College London, London, United Kingdom
Biography:
Dr Hannah Wallace is a nephrologist at Western Health in Melbourne. She is a PhD candidate at Melbourne University and The George Institute for Global Health, with her research focus on understanding current patterns of chronic kidney disease care and exploring models to improve care. She has a keen interest in digital health and is a honorary clinical fellow with the Centre for Digital Transformation of Health, University of Melbourne.
Aim:
To explore sex-related differences in monitoring and cardiovascular risk management of chronic kidney disease (CKD) in primary care.
Background:
There has been limited systematic assessment of sex-related differences in CKD management.
Methods:
We identified adults with CKD who attended a general practice participating in MedicineInsight (2011-2020). Sex differences in monitoring and management were assessed within 18months of meeting diagnostic CKD criteria. Core monitoring was defined as ≥1 measurement of all of blood pressure, eGFR, UACR, lipids and, in diabetics, HbA1c. Cardiovascular risk management comprised ACEi/ARB and statin prescriptions, blood pressure and lipid control. Adjusted modified Poisson regression determined the relative risk (RR) of outcomes in females vs. males (overall and within subgroups [age, comorbidities and CKD risk categories]).
Results:
Of 140,774 patients with CKD, 51.4% were female. Females were older (mean age: 75.8 vs. 72.7years) and had less prevalent CVD and diabetes. Females were less likely than males to receive core monitoring (RR [95% CI], 0.96 [0.95-0.98]), ACEi/ARB prescription (0.96 [0.95-0.97]; no difference in statin prescription), blood pressure targets (<140/90mmHg: 0.96 [0.95-0.97]) and LDL <2mmol/L (0.82 [0.80-0.84]). Females were less likely to be monitored with advancing age (age 60-79, 0.97 [0.95-0.99]; age >80, 0.92 [0.89-0.95], interaction p<0.001), and co-existing CVD, diabetes or hypertension (0.95 [0.92-0.98], 0.98 [0.96-0.99], 0.96 [0.93-0.99], respectively). There were similar trends across ACEi/ARB prescription, blood pressure and lipid control. Females were less likely to be monitored in moderately increased and high-risk CKD categories, with no difference in the very high-risk group (interaction p<0.001).
Conclusion:
Overall, females with CKD were less likely to receive CKD monitoring and cardiovascular risk management. Findings largely persisted in advancing age, comorbidity and CKD risk categories.
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