Male and female drug prescription patterns and adverse drug reactions in chronic kidney disease.

Background: It is acknowledged that men and women differ with regard to pharmacological responses and adverse drug reactions (ADRs), and there is some evidence to suggest that ADR rates are higher in women. However, this topic has not been extensively explored in patients with chronic kidney disease (CKD). The objectives of the present study of a cohort of patients with CKD were to describe the types of drug prescriptions by sex and to examine potential differences between men and women in the incidence of ADRs.

Methods: 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 (eGFR<60 mL/min/1.73 m²) and available data on drug prescriptions. Standard descriptive analyses were conducted to characterize drug prescriptions by gender through follow-up. ADRs were prospectively identified through hospitalization records, medical records, and patient interviews and adjudicated by expert pharmacologists using validated tools. Multivariable Cox proportional hazards model was used to explore the association between sex and ADRs.

Results: Among the 3,011 included patients, 1,038 (34%) were women and 1,973 (66%) were men. Compared with men at baseline, women were younger (median [interquartile range] age: 69 [62-77] years vs 67 [58-76], respectively), and had a lower eGFR (mean ± standard deviation, 33.1±12.9 vs 34.7±13.2 mL/min/1.73 m²). Men and women presented some differences with regard to the types of drugs prescribed. Women were more often prescribed drugs for acid-related disorders, anemia, thyroid disorders, analgesics, and psychoactive drugs. Conversely, they were less often prescribed cardiovascular drugs and oral antidiabetics. During a median [interquartile range] follow-up period of 5.0 [3.6-5.2] years, 964 patients experienced a first ADR (incidence rates [95%CI]: 10.8 [9.6-11.9] per 100 person-years (PY) in women and 9.7 [9.0-10.5] in men). The most frequent ADRs were gastrointestinal disorders in women (n=59(17%)) and renal and urinary disorders in men (n=134 (22%)). The likelihood of a first ADR was higher in women than in men (adjusted HR [95%CI]: 1.17 [1.02;1.34]). However, the likelihood of a serious ADR did not differ by sex.

Conclusions: In patients with CKD, significant differences between men and women were observed in drug prescriptions and ADR risks.