[Poster]#1856 Exploring sex-based variations in prescription patterns and adverse drug reactions in chronic kidney disease
Résumé
Background and Aims Pharmacological responses and risks can differ significantly between sexes. In the general population, women are more likely than men to experience adverse drug reactions (ADRs). However, sex-based differences in the therapeutic management of comorbidities among patients with chronic kidney disease (CKD) remain poorly described, and the disparity in ADR risk between sexes is largely unknown. This study aims to describe the prevalence and types of drug prescriptions in men and women and to examine sex differences in the risk of ADRs within a cohort of CKD patients. Method The French Chronic Kidney Disease-Renal Epidemiology and Information Network (CKD-REIN) is a prospective cohort study including 3,011 nephrology outpatients with confirmed CKD (estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m²) and available data on drug prescriptions. Standard descriptive analyses were conducted to characterize drug prescriptions according to sex at baseline. ADRs were prospectively identified through hospitalization records, medical records, and patient interviews. Expert pharmacologists used validated tools to adjudicate ADRs. Cause-specific Cox proportional hazards model was used to explore the association between sex. The model was adjusted for baseline comorbidities, laboratory data, and medications. Results Among the 3,011 included patients, 1,038 were women (W) and 1,973 were men (M). Compared to men, at baseline, women were younger (median [interquartile range], 67 [58–76] vs 69 [62–77] years, P < 0.001), had lower eGFR (mean ± standard deviation, 33.1 ± 12.9 vs 34.7 ± 13.2 mL/min/1.73 m², P = 0.001), and lower rates of diabetes, hypertension, cardiovascular disease, and dyslipidaemia, but higher prevalence of arthrosis and depression. No statistical differences were observed in anaemia prevalence. Although the number of daily-prescribed medications did not differ by sex (P = 0.13), the types of drugs prescribed varied significantly between men and women. Women were more frequently prescribed drugs for acid related disorders (37% vs 33%), antianemic preparations (23% vs 12%), corticosteroids (9% vs 6%), thyroid therapy (23% vs 6%), analgesics (30% vs 20%), psycholeptics (24% vs 13%), and psychoanaleptics (12% vs 6%). In contrast, they were less frequently prescribed drugs related to cardiovascular health, including antithrombotic agents (41% vs 59%), diuretics (51% vs 57%), calcium channel blockers (44% vs 50%), renin-angiotensin system inhibitors (71% vs 79%) or lipid-modifying agents (57% vs 66%), and oral antidiabetic agents (20% vs 26%). No significant differences were observed for vitamin D supplementation (W, 49%; M, 48%) and beta-blockers (W, 40%; M, 43%). During a median follow-up of 4.7 [4.6–4.8] years, 964 patients experienced a first ADR (W = 351; M = 613), leading to a global incidence rate of 10.1 [9.5; 10.7] per 100 person-years. The most common ADRs were renal and urinary disorders (n = 178), followed by gastrointestinal disorders (n = 145) and haemorrhages (n = 107). Among women, the most frequent ADRs were gastrointestinal disorders (n = 59), while renal and urinary disorders were most common in men (n = 134). The adjusted risk of a first ADR was higher in women than in men (hazard ratio [95% confidence interval], 1.17 [1.02; 1.34]). Conclusion In CKD patients, significant sex-based differences were observed in drug prescriptions and ADR risks. Women had distinct prescription patterns, with fewer cardiovascular drugs but more psychoactive and analgesic medications. They also exhibited a higher risk of ADRs, highlighting the need for sex-specific therapeutic strategies.
