Primary Care–Based Chronic Kidney Disease Management—Reply

In Reply We appreciate the letter from Dr Hu regarding additional points of consideration for our study on CKD. We agree that it is critical to consider pregnancy in studies assessing sex disparities in health care. For our study, females of reproductive age accounted for only 0.8% of our cohort (n = 35). We did not expect this small number of patients to change our results, so we did not plan a subgroup analysis. However, the care of patients before, during, and after pregnancy highlights opportunities for future research. For example, although angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are contraindicated in pregnancy, the resumption of guideline-concordant medications after pregnancy is necessary to prevent exacerbation of existing disparities. Similarly, future analyses of CKD care stratified by race and ethnicity during pregnancy and the postpartum period will be important and may shed light on disparities in gestational hypertension, postpartum hypertension, and long-term cardiovascular outcomes.