What We Do and Do Not Know about Women and Kidney Diseases; Questions Unanswered and Answers Unquestioned: Reflection on World Kidney Day and International Women’s Day

Abstract

Chronic kidney disease affects approximately 10% of the world’s adult population: it is within the top 20 causes of death worldwide, and its impact on patients and their families can be devastating. World Kidney Day and International Women’s Day in 2018 coincide, thus offering an opportunity to reflect on the importance of women’s health and specifically their kidney health, on the community and the next generations, as well as to strive to be more curious about the unique aspects of kidney disease in women so that we may apply those learnings more broadly. Girls and women, who make up approximately 50% of the world’s population, are important contributors to society and their families. Gender differences continue to exist around the world in access to education, medical care, and participation in clinical studies. Pregnancy is a unique state for women, offering an opportunity for diagnosis of kidney disease, but also a state where acute and chronic kidney diseases may manifest, and which may impact future generations with respect to kidney health. There are various autoimmune and other conditions that are more likely to have an impact on women, with profound consequences for child bearing, and on the fetus. Women have different complications on dialysis than men, and are more likely to be donors than recipients of kidney transplants. In this editorial, we focus on what we do and do not know about women, kidney health, and kidney disease, and what we might learn in the future to improve outcomes worldwide.

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

“…Notably, CKD in women has profound consequences for global health, since it substantially increases the risk of premature delivery, infants who are small for their gestational age and low birth weight [4], which predispose the next generation to a higher risk for NCD [5, 6]. In 2018, the celebration of World Kidney Day is dedicated to women’s health [7], with the major aims being to increase awareness of CKD in the female population and improve kidney health care for women. In this article, we explore global gender disparities in CKD prevalence based on data from the GBD 2016 Study.…”

Perspectives of Nephrologists on Gender Disparities in Access to Kidney Transplantation

“…Globally, reducing gender disparities in access to care is a high priority across many areas in medicine and health. 39–42 There is recognition of the need for efforts targeted at improving health education, developing and applying innovative methods and new approaches in gender science, empowering autonomy in decision making for everyone, facilitating access to economic resources, addressing shame and gender stereotypes, and advocating for gender-transformative health policies and laws, particularly for women. 43–47 Some international initiatives, such as the Transplantation Society and Women in Transplantation, have been launched to address gender disparities in access to kidney transplantation by providing education to eliminate gender bias within institutions and among health care providers, ensuring strategies to improve participation of women in the transplant process and equity in access to care, engaging in advocacy and communication to change ingrained attitudes, strengthening health literacy among women, addressing values and beliefs in gender-specific roles/duties, and establishing gender-specific support groups.…”

The Impact of Recipient Demographics on Outcomes from Living Donor Kidneys: Systematic Review and Meta-Analysis

“…With regards to sex, an interesting finding of our meta-analysis was that at three years follow up, male recipients who had received a transplant from a male donor were 65% less likely to lose a graft compared to male recipients who have received grafts from female donors. This result might lead to think there is a nephron mass effect playing an increasing role in the medium and long-term graft function, as a female kidney could be in general of lower weight and therefore with less functional nephrons, demonstrated also by a lower eGFR in women in the general population [ 35 ].…”