Kidney Disease & Women

While kidney disease can affect people of all ages and races,

women tend to face more specific challenges linked to kidney disease. The risk of developing Chronic Kidney Disease (CKD) is at least as high in women as in men and may even be higher. CKD affects approximately 195 million women worldwide and it is currently the 8th leading cause of death in women, causing 600,000 deaths each year [1]. CKD poses risk of morbidity and in many cases progreses towards the renal failure, requiring renal replacement therapy – dialysis and/or kidney transplantation

What types of kidney disease are more common in women?

Lupus Nephritis (LN) is  a kidney damage, caused by an autoimmune disease (systemic lupus erythematosus, aka SLE) —a disorder in which the body’s immune system attacks the body’s own cells and tissues. Kidney disease caused by lupus may get worse over time and lead to kidney failure. SLE is much more common in women than in men and most often strikes during the child-bearing years. Nine out of 10 people who have SLE are women.

Pyelonephritis (kidney infection) is a type of urinary tract infection (UTI) that is most commonly caused by bacteria and starts in the lower urinary tract. If  not treated, it moves upstream to one of both kidneys. Kidney infections may lead to sepsis, which can be life threatening. UTI is more common in women and girls due to their anatomy.

What are the challenges unique to women?

Conception –  CKD is considered to be a risk factor for reduced fertility, especially in its advanced stage, when dialysis is required. While conception on dialysis may be challenging, it is still possible and the results improve with intensive treatment (daily or nearly daily) sessions.

Pregnancy-related complications – both Acute Kidney Injury (AKI) and preeclampsia (PE) may lead to the development of CKD. Preeclampsia  – a complication of pregnancy, caused by placental insufficiency or maternal factors/diseases, and  leading to high blood pressure and kidney damage in the mother. It does not only pose threats to maternal health, but is also associated with intrauterine and perinatal death, preterm delivery and restricted intrauterine growth.
Any kind of  pre-existing kidney disease in the mother has a negative effect on pregnancy and may pose a threat to the health of mother and the fetus.  There is an increase chance of adverse pregnancy outcomes in women with CKD, including preeclampsia, AKI,  CKD progression, spontaneous abortion, stillbirth, malformations, and other long-term issues.

Access to healthcare – socioeconomic and cultural issues may affect women’s wellbeing. Septic abortion after an illegal procedure is the leading cause of AKI in countries with no access to legal abortion. The burden of those maternal complications is particularly high for women in developing countries, due to insufficient access to universal and timely prenatal care, improper management of women with preeclampsia, and lack of availability of dialysis for severe AKI [2].
Access to Renal Replacement Therapies (RRT), including dialysis and transplantation, may be of concern for some women and girls in many societies. While women are more likely to donate a kidney for transplantation, they are less likely to receive one, when in need [3].

In 2018, World Kidney Day’s theme was “Women & Kidney Disease”. In partnership with the Taskforce on Women and Non-Communicable Disease,  World Kidney Day has developed a policy document  on “Kidney Disease & Women”. The statement highlights current evidence and key challenges in the areas of kidney disease and maternal and child health, access to kidney care and prevention of kidney disease and sets out concrete policy recommendations to address these issues.

You can also read a Scientific Editorial written on occasion of World Kidney Day 2018 : 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.

 

[1] Data on prevalence and mortality in women taken from GBD website: https://vizhub.healthdata.org/gbd-compare/

[2] Maternal mortality from preeclampsia/eclampsia: https://www.ncbi.nlm.nih.gov/pubmed/22280867
[3] Chronic Kidney Disease, Gender, and Access to Care: A Global Perspective: https://www.ncbi.nlm.nih.gov/pubmed/28532558

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