The theme of this year’s World Kidney Day — kidneys and women’s health — highlights an important but often neglected area of nephrology and, more broadly, of global health. Chronic kidney disease (CKD) is under-recognized despite its negative impact on morbidity and mortality and huge societal costs. Even less attention is given to sex differences in nephrology research, despite evidence of sex-specific differences in kidney function and in the epidemiology, diagnosis, underlying mechanisms, natural history and outcomes of CKD, as well as the need to consider the reproductive health of affected women and the renal and wider health of their offspring.
Epidemiological studies suggest that predialysis CKD is more prevalent in women than in men, and women are more likely than men to be kidney donors, but more men than women receive dialysis or undergo kidney transplantation. The factors that contribute to these disparities are complex and likely involve biological differences that affect the rate of CKD progression and transplantation criteria (such as the presence of preformed antibodies), as well as sociocultural influences that affect access to care.These insights are important, not only to highlight differences in the prevalence and outcomes of kidney disease in men and women, but also to identify strategies to prevent and target CKD. Greater understanding of the biological mechanisms that underlie sex-specific differences in the prevalence and progression of CKD will potentially aid the identification of new treatment targets, whereas awareness of sociocultural influences might open avenues to be addressed by clinicians, policy makers and other communities.
Reproductive health and pregnancy are important issues for women with CKD and are explored in a second Review by Kate Wiles and colleagues. CKD is associated with reduced fertility and an increased risk of adverse pregnancy outcomes such as pre-eclampsia, preterm delivery and fetal growth restriction. Moreover, low birth weight is a risk factor for hypertension and kidney disease in later life1, perpetuating the cycle. In their Review, Wiles and colleagues discuss fertility issues and contraceptive options for patients with CKD. They describe the renal physiological changes that occur during pregnancy, the contribution of CKD and common comorbidities to pregnancy complications and approaches to the diagnosis and therapeutic management of CKD during pregnancy — an area of much needed research given that few studies have assessed drug safety in pregnant women.
