What we do and do not know about women and kidney diseases; questions unanswered and answers unquestioned: reflection on World Kidney Day and International Women’s Day

Abstract

Chronic Kidney Disease affects approximately 10% of the world's adult population: it is within the top 20 causes of death worldwide, and its impact on patients and their families can be devastating. World Kidney Day and International Women's Day in 2018 coincide, thus offering an opportunity to reflect on the importance of women's health and specifically their kidney health, on the community, and the next generations, as well as to strive to be more curious about the unique aspects of kidney disease in women so that we may apply those learnings more broadly. Girls and women, who make up approximately 50% of the world's population, are important contributors to society and their families. Gender differences continue to exist around the world in access to education, medical care, and participation in clinical studies. Pregnancy is a unique state for women, offering an opportunity for diagnosis of kidney disease, but also a state where acute and chronic kidney diseases may manifest, and which may impact future generations with respect to kidney health. There are various autoimmune and other conditions that are more likely to impact women with profound consequences for child bearing, and on the fetus. Women have different complications on dialysis than men, and are more likely to be donors than recipients of kidney transplants. In this editorial, we focus on what we do and do not know about women, kidney health, and kidney disease, and what we might learn in the future to improve outcomes worldwide.

The Spectrum of Adverse Pregnancy Outcomes Based on Kidney Disease Diagnoses: A 20-Year Population Study

“…Pregnancy provides a particular opportunity to identify underlying kidney disease but much remains to be done to improve outcomes for women and future generations, as emphasized in expert reflections from the 2018 International Society of Nephrology World Kidney Day [35]. In this large, retrospective observational cohort analysis, 0.3% of births were reported to have a maternal kidney condition, likely indicating under-recognition by clinical teams with potential missed diagnosis of kidney disease in women with pregnancy complications.…”

Delayed Initiation of Hemodialysis in Pregnant Women with Chronic Kidney Disease: Logistical Problems Impact Clinical Outcomes. An Experience from an Emerging Country

“…While the disease has a higher prevalence in the elderly, no age is spared and CKD is also a relevant problem in women of childbearing age. The prevalence of CKD may be higher in women than in men, even if the latter are more likely to develop end-stage renal disease (ESRD) [1].…”

The pregnancy outcomes in patients with stage 3–4 chronic kidney disease and the effects of pregnancy in the long-term kidney function

“…Many studies have evaluated the pregnancy outcomes of women with CKD and the effects of pregnancy on the progression of kidney diseases. They show that although the incidence of adverse pregnancy outcomes is significantly increased with respect to healthy women, patients with essentially normal renal function usually have acceptable pregnancy outcomes, and pregnancy does not have an obvious effect on kidney disease progression, although proteinuria may be a marker of renal function worsening [ 5 – 10 ]. However, patients with moderate to severe renal impairment at early pregnancy have a significantly increased risk of adverse pregnancy outcomes, and pregnancy may accelerate kidney disease progression in these patients.…”