Several epidemiologic studies have demonstrated that women have an increased incidence of chronic kidney disease (CKD) ( ), but are less likely than their male counterparts to progress to end-stage kidney disease (ESKD) ( ). Several theories have been proposed to explain this discrepancy, including that women may have slower progression of CKD, are more likely to die prior to starting dialysis, or are more likely to opt for conservative care, rather than proceed with a kidney transplant or dialysis ( ). A recent study by Ricardo , published in the , provides new insights into sex differences in CKD progression by analyzing the Chronic Renal Insufficiency Cohort (CRIC), a large, well-characterized cohort of patients with CKD that has a median of 7 years of follow-up ( ). Similar to prior studies, the authors identified that women were less likely to progress to ESKD [adjusted hazard ratio (HR) 0.72, 95% confidence interval (CI): 0.59–0.87], less likely to have a decline in estimated glomerular filtration rate (eGFR) of 50% (adjusted HR 0.82, 95% CI: 0.69–0.96), and had a lower risk of death (adjusted HR 0.56, 95% CI: 0.44–0.70). This difference remained significant after extensive adjustment for clinical and socio-demographic factors, confirming what appears to be a true sex difference in the risk of ESKD. However, the study also raises interesting questions for future study, including the role of sex hormones in disease progression and what role sex differences in the complications and prognosis of CKD should play in the care of patients.
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