Women and Kidney Disease: Reflections on World Kidney Day 2018

Kidney Health and Women's Health: A Case for Optimizing Outcomes for Present and Future Generations

Giorgina B. Piccoli; Mona Alrukhaimi; Zhi-Hong Liu; Elena Zakharova; Adeera Levin

Disclosures

Nephrol Dial Transplant. 2018;33(2):189-193. 

In This Article

What We Know and Do Not Know

Pregnancy

Pregnancy is a unique challenge and a major cause of acute kidney injury (AKI) in women of childbearing age.[2] AKI and preeclampsia (PE) may lead to subsequent CKD, but quantification of this risk is not known. PE is a risk factor for the future development of CKD and end-stage renal disease (ESRD) in the mother[3] and is the principal cause of AKI and maternal death in developing countries.[4] Furthermore, PE is linked to 'small babies', who are at risk for developing diabetes, metabolic syndrome, cardiovascular diseases (CVDs) and CKD in adulthood.[5]

The presence of any degree of CKD has a negative effect on pregnancy, and given the increase in the risk of CKD progression postpartum, it raises challenging ethical issues around conception and the maintenance of pregnancies. Table 1 describes the various potential adverse effects of pregnancy on kidney health.

Autoimmune Diseases

Autoimmune diseases such as systemic lupus erythematosus (SLE), rheumatoid arthritis (RA) and systemic scleroderma (SS) preferentially affect women and are characterized by systemic inflammation leading to target organ dysfunction, including the kidneys. Sex differences in the incidence and severity of these diseases result from a complex interaction of hormonal, genetic and epigenetic factors (Table 2). The public health burden of autoimmune diseases is substantial as a leading cause of morbidity and mortality among women throughout adulthood.[6–8]

Renal Replacement Therapies (RRTs)

The prevalence of CKD in women is always less than in men and they have slower progression to ESRD.[9] Women with CKD have a higher cardiovascular risk than women without CKD.[10]

Access to RRT in general is inequitable around the world.[11] The equality of access to RRT for women and girls is of concern because, in many societies, they are disadvantaged by discrimination rooted in sociocultural factors. There is a paucity of information about sex differences in RRT, but in multiple countries, men are reported to be more likely than women to receive dialysis.[11,12]

Women are more likely to donate kidneys for transplantation than to receive them, as reported from multiple countries. They are also less likely to be registered on transplant waiting lists and wait longer from dialysis initiation to listing. Mothers are more likely to be donors, as are female spouses.[13,14]

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