World Kidney Day: Kidneys & Women’s Health

Women typically experience a survival advantage over men in the general population, but this advantage is largely attenuated for women with chronic kidney disease (CKD) on dialysis. While biological factors are likely to contribute to this finding, a gender gap in both the access to and quality of care for CKD may also play a major role. This gap is generally unaccounted for in established recommendations for managing CKD and connecting patients with the right care resources.

This year, the World Kidney Day theme is focused on women with CKD in an effort to raise awareness and to facilitate women’s access to CKD education and care. Increased awareness of sex- and gender-specific risk factors for kidney disease and a treatment approach that acknowledges unique sex and gender differences may help improve clinical outcomes and quality of life for women with CKD around the world.

There is evidence of important sex and gender disparities in patients with kidney disease:

• CKD is more common in women than men. According to a 2016 meta-analysis, the average CKD prevalence is 14 percent in women and 12 percent in men.
• Despite this, more men receive dialysis than women. This may be due to the fact that women tend to progress to end stage renal disease more slowly than men.
• Women also often initiate dialysis later than men, which may be linked to not seeking timely medical care.
• Women are less likely than men to initiate dialysis with an arteriovenous fistula (AVF) (and, in turn, more likely to use a central venous catheter).
• Women on dialysis are more likely to experience access complications, such as AVF maturation failure, AVF failure and ischemic steal syndrome.
• Women on dialysis average 2.1 hospitalizations per year, whereas men average 1.7 hospitalizations.
• Women on dialysis are more likely than men to be re-hospitalized after 30 days of being discharged.
• Across socio-economical strata, women are more often kidney donors and less often kidney recipients than men.
• A larger number of women around the world have a lower education level and lower awareness of CKD than men.

Both women and men with CKD need to be cared for with an individualized approach that takes into account all of their differences, including those associated with sex and gender. On this World Kidney Day, let us acknowledge each individual woman with CKD: Not only her clinical metrics, but also her unique story, her needs and her values. As clinicians continue to move toward a patient-centered care approach, we may be able to narrow the gender gap and improve clinical outcomes and quality of life for women with CKD.