Sex Differences in Incident Stage 3 Chronic Kidney Disease: A Narrative Review.

Chronic kidney disease (CKD) progression has been shown to differ by sex, although findings across studies remain inconsistent. This narrative review examines evidence on sex differences in the development of stage 3 CKD, defined as incident estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m². A narrative literature search of PubMed was conducted to identify observational cohort studies evaluating sex-specific risk in CKD development. Findings varied by population characteristics and outcome definitions. Evidence regarding sex differences in incident stage 3 CKD is mixed, with some findings suggesting greater risk among women and others identifying male sex as a potential risk factor. Additionally, metabolic and lifestyle risk factors demonstrated sex-specific associations, with some exposures showing stronger effects in men or differing based on whether CKD was defined by eGFR decline or proteinuria. Overall, sex differences in CKD development appear to be influenced by methodological variability and population differences. Further research using standardized definitions and sex-stratified analyses is needed to clarify underlying biological and clinical mechanisms and inform sex-specific risk assessment and monitoring.