The theme of World Kidney Day 2018 is 'kidneys and women's health: include, value, empower'. To mark this event, Nature Reviews Nephrology asked four leading researchers to discuss key considerations related to women's kidney health, including specific risk factors, as well as the main challenges and barriers to care for women with kidney disease and how these might be overcome. They also discuss policies and systems that could be implemented to improve the kidney health of women and their offspring and the areas of research that are needed to improve the outcomes of kidney disease in women.
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Eckardt, K.-U. et al. Evolving importance of kidney disease: from subspecialty to global health burden. Lancet 382, 158–169 (2013).
Mills, K. T. et al. A systematic analysis of worldwide population-based data on the global burden of chronic kidney disease in 2010. Kidney Int. 88, 950–957 (2015).
Tsokos Systemic Lupus Erythematosus, G. C. N. Engl. J. Med. 365, 2110–2121 (2011).
Ramjee, G. & Daniels, B. Women and HIV in sub-Saharan Africa. AIDS Res. Ther. 10, 30 (2013).
Islam, F. M., Wu, J., Jansson, J. & Wilson, D. P. Relative risk of renal disease among people living with HIV: a systematic review and meta-analysis. BMC Public Health. 12, 234 (2012).
Dielubanza, E. J. & Schaeffer, A. J. Urinary tract infections in women. Med. Clin. North Am. 95, 27–41 (2011).
Gyamlani, G. & Geraci, S. A. Kidney disease in pregnancy:(Women's Health Series). South Med. J. 106, 519–525 (2013).
Carrero, J. J., Hecking, M., Ulasi, I., Sola, L. & Thomas, B. Chronic Kidney Disease, Gender, and Access to Care: A Global Perspective. Semin. Nephrol. 37, 296–308 (2017).
Xu, R. et al. Gender differences in age-related decline in glomerular filtration rates in healthy people and chronic kidney disease patients. BMC Nephrol. 11, 20 (2010).
Nitsch, D. et al. Associations of estimated glomerular filtration rate and albuminuria with mortality and renal failure by sex: a meta-analysis. BMJ 346, f324 (2013).
CDC Office of Women's Health. Leading Causes of Death in Females, 2014 (current listing). Centers for Disease Control and Prevention https://www.cdc.gov/women/lcod/2014/black/index.htm (2017).
Saran, R. et al. US Renal Data System 2016 annual data report: epidemiology of kidney disease in the United States. Am. J. Kidney Dis. 69, A7–A8 (2017).
Kummer, S., von Gersdorff, G., Kemper, M. J. & Oh, J. The influence of gender and sexual hormones on incidence and outcome of chronic kidney disease. Pediatr. Nephrol. 27, 1213–1219 (2012).
Benjamin, E. J. et al. Heart disease and stroke statistics — 2017 update: a report from the American Heart Association. Circulation 135, e146–e603 (2017).
Wild, S., Roglic, G., Green, A., Sicree, R. & King, H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 27, 1047–1053 (2004).
Sullivan, J. C. & Gillis, E. E. Sex and gender differences in hypertensive kidney injury. Am. J. Physiol. Renal Physiol. 313, F1009–F1017 (2017).
Inada, A. et al. Adjusting the 17beta-estradiol-to-androgen ratio ameliorates diabetic nephropathy. J. Am. Soc. Nephrol. 27, 3035–3050 (2016).
Hodis, H. N., Collins, P., Mack, W. J. & Schierbeck, L. L. The timing hypothesis for coronary heart disease prevention with hormone therapy: past, present and future in perspective. Climacteric 15, 217–228 (2012).
Afshin, A. et al. Health effects of overweight and obesity in 195 countries over 25 years. N. Engl. J. Med. 377, 13–27 (2017).
Zhang, Q. L. & Rothenbacher, D. Prevalence of chronic kidney disease in population-based studies: systematic review. BMC Public Health 8, 117 (2008).
Neugarten, J., Acharya, A. & Silbiger, S. R. Effect of gender on the progression of nondiabetic renal disease: a meta-analysis. J. Am. Soc. Nephrol. 11, 319–329 (2000).
Coresh, J. et al. Chronic kidney disease awareness, prevalence, and trends among U. S. adults, 1999 to 2000. J. Am. Soc. Nephrol. 16, 180–188 (2005).
Raymond, S. U., Greenberg, H. M. & Leeder, S. R. Beyond reproduction: women's health in today's developing world. Int. J. Epidemiol. 34, 1144–1148 (2005).
Piccoli, G. B. et al. Risk of adverse pregnancy outcomes in women with CKD J. Am. Soc. Nephrol. 26, 2011–2022 (2015).
Hoy, W. E. Kidney disease in Aboriginal Australians: a perspective from the Northern Territory. Clin. Kidney J. 7, 524–530 (2014).
Carrero, J. J. et al. Sex differences in the impact of diabetes on mortality in chronic dialysis patients. Nephrol. Dial. Transplant. 26, 270–276 (2010).
Vikse, B. E., Irgens, L. M., Bostad, L. & Iversen, B. M. Adverse perinatal outcome and later kidney biopsy in the mother. J. Am. Soc. Nephrol. 17, 837–845 (2006).
Vikse, B. E., Irgens, L. M., Leivestad, T., Skjaerven, R. & Iversen, B. M. Preeclampsia and the risk of end-stage renal disease. N. Engl. J. Med. 359, 800–809 (2008).
Kattah, A. G. et al. Preeclampsia and ESRD: the role of shared risk factors. Am. J. Kidney Dis. 69, 498–505 (2017).
Mosca, L. et al. Effectiveness-based guidelines for the prevention of cardiovascular disease in women — 2011 update: a guideline from the american heart association. Circulation 123, 1243–1262 (2011).
Bushnell, C. et al. Guidelines for the prevention of stroke in women: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 45, 1545–1588 (2014).
Scales, C. D. Jr et al. Changing gender prevalence of stone disease. J. Urol. 177, 979–982 (2007).
Levin, A. et al. Global kidney health 2017 and beyond: a roadmap for closing gaps in care, research, and policy. Lancet 390, 1888–1917 (2017).
Garg, A. X. et al. Gestational hypertension and preeclampsia in living kidney donors. N. Engl. J. Med. 372, 124–133 (2015).
Sarnak, M. J. et al. Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Hypertension 42, 1050–1065 (2003).
Cobo, G. et al. Sex and gender differences in chronic kidney disease: progression to end-stage renal disease and haemodialysis. Clin. Sci. 130, 1147–1163 (2016).
Gordon, C. et al. The British Society for Rheumatology guideline for the management of systemic lupus erythematosus in adults. Rheumatology 1, e1–e45 (2018).
Rathi, M. et al. Comparison of low-dose intravenous cyclophosphamide with oral mycophenolate mofetil in the treatment of lupus nephritis Kidney Int. 89, 235–242 (2016).
Webster, P., Lightstone, L., McKay, D. B. & Josephson, M. A. Pregnancy in chronic kidney disease and kidney transplantation. Kidney Int. 91, 1047–1056 (2017).
Ehrhardt, A. A., Sawires, S., McGovern, T., Peacock, D. & Weston, M. Gender, empowerment, and health: what is it? How does it work? J. Acquir. Immune Defic. Syndr. 51 (Suppl. 3), S96–S105 (2009).
Schmittdiel, J. et al. Missed opportunities in cardiovascular disease prevention?: low rates of hypertension recognition for women at medicine and obstetrics-gynecology clinics. Hypertension 57, 717–722 (2011).
Smyth, A., Radovic, M. & Garovic, V. D. Women, kidney disease, and pregnancy. Adv. Chron. Kidney Dis. 20, 402–410 (2013).
Smith, S. M. et al. Cardiovascular and mortality risk of apparent resistant hypertension in women with suspected myocardial ischemia: a report from the NHLBI-sponsored WISE Study. J. Am. Heart Assoc. 3, e000660 (2014).
Schwartz, J. B. Gender-specific implications for cardiovascular medication use in the elderly optimizing therapy for older women. Cardiol. Rev. 11, 275–298 (2003).
Hecking, M. et al. Sex-specific differences in hemodialysis prevalence and practices and the male-to-female mortality rate: the Dialysis Outcomes and Practice Patterns Study (DOPPS). PLoS Med. 11, e1001750 (2014).
Jindal, R. M., Ryan, J. J., Sajjad, I., Murthy, M. H. & Baines, L. S. Kidney transplantation and gender disparity. Am. J. Nephrol. 25, 474–483 (2005).
Pestana, J. M. Clinical outcomes of 11,436 kidney transplants performed in a single center — Hospital do Rim. J. Bras. Nefrol. 39, 287–295 (2017).
Ainsworth, M., Beegle, K. & Nyamete, A. The impact of women's schooling on fertility and contraceptive use: a study of fourteen sub-Saharan African countries. World Bank Econ. Rev. 10, 85–122 (1996).
Finkelstein, F. O., Smoyer, W. E., Carter, M., Brusselmans, A. & Feehally, J. Peritoneal dialysis, acute kidney injury, and the Saving Young Lives program. Perit. Dial. Int. 34, 478–480 (2014).
Kew, S. et al. Cardiometabolic implications of postpartum weight changes in the first year after delivery. Diabetes Care 37, 1998–2006 (2014).
American College of Obstetricians and Gynecologists & Task Force on Hypertension in Pregnancy. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists' Task Force on Hypertension in Pregnancy. Obstet. Gynecol. 122, 1122–1131 (2013).
von Dadelszen, P. et al. Fall in mean arterial pressure and fetal growth restriction in pregnancy hypertension: a meta-analysis. Lancet 355, 87–92 (2000).
Magee, L. A. et al. Less-tight versus tight control of hypertension in pregnancy. N. Engl. J. Med. 372, 407–417 (2015).
Baxmann, A. C. et al. Influence of muscle mass and physical activity on serum and urinary creatinine and serum cystatin C. Clin. J. Am. Soc. Nephrol. 3, 348–354 (2008).
[No authors listed.] Chronic kidney disease in adults: assessment and management. Clinical guideline [CG182]. National Institute for Health and Care Excellence https://www.nice.org.uk/guidance/cg182 (2015).
Bramham, K. et al. Diagnostic and predictive biomarkers for pre-eclampsia in patients with established hypertension and chronic kidney disease Kidney Int. 89, 874–885 (2016).
Melloni, C. et al. Representation of women in randomized clinical trials of cardiovascular disease prevention. Circ. Cardiovasc. Qual. Outcomes 3, 135–142 (2010).
Sprint Research Group et al. A randomized trial of intensive versus standard blood-pressure control. N. Engl. J. Med. 373, 2103–2116 (2015).
Sandberg, K., Ji, H. & Hay, M. Sex-specific immune modulation of primary hypertension. Cell. Immunol. 294, 95–101 (2015).
Barreto, F. C. et al. Osteoporosis in hemodialysis patients revisited by bone histomorphometry: a new insight into an old problem. Kidney Int. 69, 1852–1857 (2006).
Houssiau, F. Why will lupus nephritis trials not fail anymore? Rheumatology 56, 677–678 (2017).
Pregnancy and Chronic Kidney Disease Rare Disease Group. Pregnancy and Chronic Kidney Disease–RDG. RareRenal http://rarerenal.org/rare-disease-groups/pregnancy-and-chronic-kidney-disease-rdg/ (2017).
L.L. is grateful to have worked with and learned from thousands of women patients, as well as innumerable wise women colleagues near and far, all of whom have informed her answers.
The authors declare no competing financial interests.
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Ashuntantang, G., Garovic, V., Heilberg, I. et al. Kidneys and women's health: key challenges and considerations. Nat Rev Nephrol 14, 203–210 (2018). https://doi.org/10.1038/nrneph.2017.188