Chronic kidney disease affects hundreds of millions worldwide, yet the care a patient receives may be systematically shaped by gender long before a diagnosis is ever made. A comprehensive new synthesis reveals that women face compounding disadvantages at virtually every sequential step of CKD management — a pattern that, taken together, amounts to a structural gap in nephrology care that individual clinician bias alone cannot explain.
Drawing on 35 studies across diverse geographic regions, this PROSPERO-registered systematic review — conducted under PRISMA guidelines and screening 1,140 articles from four major databases — found that women carry measurably lower odds of receiving a formal CKD diagnosis or nephrology referral, experience less frequent kidney function monitoring, and are prescribed guideline-recommended medications at lower rates than men. Among patients who progress to kidney failure requiring dialysis, women represent only 38–41% of the prevalent dialysis population and begin dialysis at lower estimated glomerular filtration rates (roughly 8.1–10.1 mL/min/1.73 m²) compared to men (approximately 10.6 mL/min/1.73 m²), suggesting later or more reluctant initiation of life-sustaining treatment. Disparities in vascular access preparation and transplantation access were also documented.
These findings carry important implications for how the field interprets existing CKD epidemiology. Women are known to have lower average muscle mass, which compresses creatinine-based GFR estimates — yet this review suggests the gap persists even accounting for such biological confounders, pointing toward social determinants: caregiver roles limiting clinic attendance, physician anchoring on male-derived clinical norms, and implicit bias in referral decisions. The systematic nature of this review strengthens causal inference compared to single-cohort studies, though heterogeneity across health systems limits direct policy extrapolation. The finding that disadvantage accumulates across multiple care nodes — rather than concentrating at one decision point — is particularly significant and suggests interventions must be systemic rather than targeted at a single bottleneck. This work is incremental in confirming known disparities but potentially paradigm-shifting in mapping their full longitudinal architecture.