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 impact 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.
Highlights
Malformations are not increased in Chronic kidney disease (CKD) patients not treated by teratogen drugs (MMF, mechanistic target of rapamycin (mTor) inhibitors, angiotensin-converting-enzyme inhibitor (ACEi), angiotensin II receptor blockers (ARBs)); exception: diabetic nephropathy; hereditary diseases, such as polycystic kidney disease (PKD), reflux nephropathy, CAKUT may be evident at birth
If women are more likely to be living donors, at differential ages, does this impact both cardiovascular disease risk, and risk for ESKD: have we studied this well enough, in the current era, with modern diagnostic criteria for CKD and sophisticated tools to understand renal reserve? Are the additional exposures that women have after living donation compounded by hormonal changes on vasculature as they age? And are the risks of CKD and PE increased in the younger female kidney living donor?
In the context of specific therapies for the treatment or delay of CKD progression, do we know if there are sex differences in therapeutic responses to angiotensin-converting-enzyme inhibitor/angiotensin II receptor blocker? Should we look at dose finding/adjustments by sex? If vascular and immune biology is impacted by sex hormones as described earlier, do we know the impact of various therapies by level or ratio of sex hormones? In low–middle income countries, how does changing economic and social cultures impact women’s health, and what is the nutritional impact on CKD of increasing predominance of obesity, diabetes, and hypertension?
Summary
What We Do and Do Not Know About Women and Kidney Diseases; Questions Unanswered and Answers Unquestioned: Reflection on World Kidney Day and International Woman’s Day. In various locations around the world, access to education and medical care is not equitable among men and women; women remain underrepresented in many clinical research studies, limiting the evidence base on which to make recommendations to ensure best outcomes (Figure 1). In this editorial, we focus on what we do and do not know about women’s kidney health and kidney disease, and what we might learn in the future to improve outcomes for all
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