Sex and gender disparities in the epidemiology and outcomes of chronic kidney disease

Abstract

Improved understanding of sex and gender-specific differences in the aetiology, mechanisms and epidemiology of chronic kidney disease (CKD) could help nephrologists better address the needs of their patients. Population-based studies indicate that CKD epidemiology differs by sex, affecting more women than men, especially with regard to stage G3 CKD. The effects of longer life expectancy on the natural decline of glomerular filtration rate (GFR) with age, as well as potential overdiagnosis of CKD through the inappropriate use of GFR equations, might be in part responsible for the greater prevalence of CKD in women. Somewhat paradoxically, there seems to be a preponderance of men among patients starting renal replacement therapy (RRT); the protective effects of oestrogens in women and/or the damaging effects of testosterone, together with unhealthier lifestyles, might cause kidney function to decline faster in men than in women. Additionally, elderly women seem to be more inclined to choose conservative care instead of RRT. Dissimilarities between the sexes are also apparent in the outcomes of CKD. In patients with predialysis CKD, mortality is higher in men than women; however, this difference disappears for patients on RRT. Although access to living donor kidneys among men and women seems equal, women have reduced access to deceased donor transplantation. Lastly, health-related quality of life while on RRT is poorer in women than men, and women report a higher burden of symptoms. These findings provide insights into differences in the underlying pathophysiology of disease as well as societal factors that can be addressed to reduce disparities in access to care and outcomes for patients with CKD.

Modest rates and wide variation in timely access to repeat kidney transplantation in the United States

“…Similar to improving care for the general ESRD population, these factors likely involve earlier recognition of the need for repeat transplant as well as care coordination with community caregivers . Interestingly, the current findings indicated higher incidence of preemptive care among women with graft failure, which is contrary to results demonstrating lower access to primary kidney transplantation among women . Results further highlighted that the increased PRLT rates were apparent in younger but not older women.…”

“…28,29 Interestingly, the current findings indicated higher incidence of preemptive care among women with graft failure, which is contrary to results demonstrating lower access to primary kidney transplantation among women. 11,30,31 Results further highlighted that the increased PRLT rates were apparent in younger but not older women. The explanation for these differences requires further study, including whether rates of renal function decline during graft failure and causes of graft failure differ by gender.…”

Incidence, Prevalence, and Duration of Chronic Kidney Disease in Taiwan: Results from a Community-Based Screening Program of 106,094 Individuals

“…A sex difference in the epidemiologic features of CKD was observed; specifically, women exhibit a higher proportion of predialysis CKD than men in most regions, with the opposite findings in Japan and Singapore [34]. We observed a sex difference in the epidemiology of CKD in our study, with lower prevalence and incidence in women than in men.…”

Disparities in Chronic Kidney Disease Prevalence among Males and Females in 195 Countries: Analysis of the Global Burden of Disease 2016 Study

“…The estimated male:female ratio for CKD that we considered reflects complex interactions between many factors, including gender differences in the prevalence of risk factors for CKD development and progression, attention to personal health care, access to medical care, availability of medications and access to RRT [14, 15]. The latter represents one of the most sensitive indicators related to the human right for life.…”

“…However, this cannot be the only explanation for male predominance on RRT, since it occurs all over the world and in all GDP per capita ranges. Biological factors responsible for higher male prevalence rates on dialysis include the protective effects of estrogen in women and damaging effects of testosterone in men [15], as well as the higher prevalence of NCD risk factors in the general male population [21, 22] and, related to this, faster CKD progression rates in males [23]. The interplay between all factors may be very complex and poorly explained.…”