Supplementary Material for: Disparities in Chronic Kidney Disease Prevalence among Males and Females in 195 Countries: Analysis of the Global Burden of Disease 2016 Study

<b><i>Background:</i></b> Chronic kidney disease (CKD) imposes a substantial burden on health care systems. There are some especially vulnerable groups with a high CKD burden, one of which is women. We performed an analysis of gender disparities in the prevalence of all CKD stages and renal replacement therapy (defined as impaired kidney function [IKF]) in 195 countries. <b><i>Methods:</i></b> We used estimates produced by the Global Burden of Disease (GBD) Study 2016 revision using a Bayesian-regression analytic tool, DisMoD-MR 2.1. Data on gross domestic product based on purchasing power parity per capita (GDP PPP) was obtained via the World Bank International Comparison Program database. To estimate gender disparities, we calculated the male:female all-age prevalence rate ratio for each IKF condition. <b><i>Results:</i></b> In 2016, the global number of individuals with IKF reached 752.7 million, including 417.0 million females and 335.7 million males. The most prevalent form of IKF in both groups was albuminuria with preserved glomerular filtration rate. Geospatial analysis shows a very heterogeneous distribution of the male:female ratio for all IKF conditions, with the most prominent contrast found in kidney transplant patients. The median male:female ratio varies substantially according to GDP PPP quintiles; however, countries with different economic states could have similar male:female ratios. A strong correlation of GDP PPP with dialysis-to-transplant ratio was found. <b><i>Conclusions:</i></b> The GBD study highlights the prominent gender disparities in CKD prevalence among 195 countries. The nature of these disparities, however, is complex and must be interpreted cautiously taking into account all possible circumstances.

**背景**：慢性肾脏病（CKD）给全球医疗卫生系统带来沉重负担。在CKD负担居高不下的诸多脆弱人群中，女性群体尤为典型。本研究针对195个国家的各分期慢性肾脏病及肾脏替代治疗（renal replacement therapy，定义为肾功能受损（IKF））的患病率性别差异展开分析。
**方法**：本研究采用全球疾病负担（GBD）研究2016修订版的估算数据，该数据集借助贝叶斯回归分析工具DisMoD-MR 2.1生成；人均购买力平价国内生产总值（GDP PPP）数据源自世界银行国际比较项目数据库。为量化性别差异，本研究针对每种肾功能受损病症，计算了男性与全年龄段女性的患病率比值。
**结果**：2016年，全球肾功能受损患者总数达7.527亿，其中女性4.170亿，男性3.357亿。两类人群中最常见的肾功能受损类型均为肾小球滤过率保留的白蛋白尿。地理空间分析显示，各类肾功能受损病症的男女性患病率比值分布异质性极强，其中肾移植患者群体的性别差异最为显著。男女性患病率比值的中位数随人均购买力平价国内生产总值五分位数分组存在显著差异，但不同经济发展水平的国家也可能呈现相近的性别患病率比值。研究还发现，人均购买力平价国内生产总值与透析-移植比值存在显著相关性。
**结论**：全球疾病负担研究揭示了195个国家中慢性肾脏病患病率存在显著的性别差异。但此类差异的形成机制较为复杂，需结合所有潜在影响因素审慎解读。