Sex, menopause and chronic kidney disease in primary care

Background and Hypothesis Sex differences in chronic kidney disease (CKD) are recognised, but how they change across the menopausal transition—and how this affects therapeutic opportunities in primary care—remains unclear Methods We performed a cross-sectional analysis of 9 526 adults from the ONDAAS primary care study with same-day serum creatinine and urine albumin-to-creatinine ratio (ACR). eGFR was estimated with CKD-EPI 2021 and CKD classified by Kidney Disease: Improving Global Outcomes 2024 eGFR (G) and albuminuria (A) categories. Using age 50 years as a proxy for menopause, we fitted age-stratified logistic regression models for CKD G3–G5 (eGFR <60 mL/min/1.73 m²) and for A2–A3 albuminuria, and applied KDIGO 2024 criteria to estimate eligibility for renoprotective and cardioprotective therapies. Results Women were 56.5% and had higher mean eGFR (84.6 vs 81.1 mL/min/1.73 m²) and lower median ACR (7.0 vs 8.3 mg/g) than men. <50 years, CKD G3 was rare in women (G3a 0.2%, G3b 0.0%); female sex reduced odds of CKD G3–G5 (aOR 0.18, 95% CI 0.05–0.69), while A2–A3 albuminuria strongly predicted CKD (aOR 33.39, 95% CI 10.41–107.13). ≥50 years, sex differences in CKD disappeared (aOR 1.01, 95% CI 0.87–1.16) and age dominated (aOR 1.13/year, 95% CI 1.12–1.14). In women ≥ 50, G3a/G3b rose to 11.3%/4.9% and G3–G4 exceeded men (17.6% vs 14.6%) despite lower A2–A3 odds (aOR 0.71, 95% CI 0.62–0.80), suggesting post-midlife eGFR–albuminuria decoupling. KDIGO 2024 eligibility in women ≥ 50: RASi 12.1%, SGLT2i 18.7%, nsMRA 3.6%, statins 35.2% (substantial opportunities even with A1–A2 albuminuria). Conclusion In this primary care population, sex differences in CKD are strongly age-dependent: women are protected before midlife, but this advantage disappears beyond age 50 years, with convergence of CKD G3-G5 risk despite differences in albuminuria. These findings support sex- and menopause-aware CKD screening and guideline-directed renoprotective and cardioprotective therapy in older women even in the absence of overt albuminuria.