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Differences in the epidemiology, management and outcomes of kidney disease in men and women

Nature Reviews Nephrology volume 20, pages 7–20 (2024)Cite this article

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Abstract

Improved understanding of differences in kidney disease epidemiology, management and outcomes in men and women could help nephrologists to better meet the needs of their patients from a sex- and gender-specific perspective. Evidence of sex differences in the risk and outcomes of acute kidney injury is mixed and dependent on aetiology. Women have a higher prevalence of chronic kidney disease (CKD) stages 3–5 than men, whereas men have a higher prevalence of albuminuria and hence CKD stages 1–2. Men show a faster decline in kidney function, progress more frequently to kidney failure and have higher mortality and risk of cardiovascular disease than women. However, the protective effect of female sex is reduced with CKD progression. Women are less likely than men to be aware of, screened for and diagnosed with CKD, started on antiproteinuric medication and referred to nephrologist care. They also consistently report a poorer health-related quality of life and a higher symptom burden than men. Women experience greater barriers than men to access the waiting list for kidney transplantation, particularly with respect to older age and obesity. However, women also have longer survival than men after transplantation, which may partly explain the comparable prevalence of transplantation between the sexes.

Key points

  • The evidence for sex differences in risk and outcomes of acute kidney injury in the inpatient setting is mixed and related to aetiology.

  • The prevalence of chronic kidney disease (CKD) stages 3–5 is higher in women, whereas the prevalence of CKD stages 1–5 may be higher in men owing to their greater prevalence of albuminuria.

  • The cut-offs given by the current Kidney Disease: Improving Global Outcomes to define the stages of CKD are not sex specific and overestimate the prevalence of albuminuria in women; consequently, the sex difference in albuminuria may be larger than is apparent from current data.

  • Men tend to experience a faster decline in kidney function than women, resulting in a higher risk of kidney failure; this faster decline is partly caused by a greater prevalence of unhealthy lifestyle behaviours and is reflected by the higher levels of albuminuria found in men.

  • Women with CKD are less likely than men to be aware of their condition, screened for and diagnosed with CKD and referred to nephrologist care and are more likely to experience adverse drug reactions.

  • Women may experience more barriers than men to access the transplant waiting list but have better survival than men after transplantation, which may contribute to the similar prevalence of transplantation between the sexes.

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Fig. 1: The prevalence of CKD stages 3–5 in men and women.
Fig. 2: The prevalence of CKD stages 1 and 2 in men and women.
Fig. 3: The incidence of kidney replacement therapy in men and women.
Fig. 4: The distribution of KRT treatment modality in men and women.

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Acknowledgements

J.J.C. acknowledges grant support from the Swedish Research Council, the Swedish Heart and Lung Foundation and the Westman and Rind foundations. K.J.J. acknowledges grant support from the European Renal Association (ERA).

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Authors and Affiliations

  1. ERA Registry, Amsterdam UMC location University of Amsterdam, Medical Informatics, Amsterdam, Netherlands

    Nicholas C. Chesnaye & Kitty J. Jager

  2. Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands

    Nicholas C. Chesnaye & Kitty J. Jager

  3. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

    Juan Jesus Carrero

  4. Division of Nephrology, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden

    Juan Jesus Carrero

  5. Department of Internal Medicine III, Clinical Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria

    Manfred Hecking

  6. Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria

    Manfred Hecking

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Chesnaye, N.C., Carrero, J.J., Hecking, M. et al. Differences in the epidemiology, management and outcomes of kidney disease in men and women. Nat Rev Nephrol 20, 7–20 (2024). https://doi.org/10.1038/s41581-023-00784-z

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