Women and Kidney Disease – The Present and the Future
Year: 2025
Type: article
Abstract: “Women’s health needs to be front and center – It often isn’t, but it needs to be.” Women constitute nearly 50% of the world’s population. They play an essential role in families and communities, significantly shaping future generations. Their health needs differ from those of men in various ways.[1] Globally, women’s health issues demand more attention than they currently receive. Maternal and child health concerns are among the most prevalent problems affecting women worldwide. However, it is crucial to recognize that women face health challenges that extend beyond reproductive health. They are more vulnerable to infections due to frailty and poor nutritional status. Tuberculosis, malaria, and human immunodeficiency virus infections are commoner in women.[2] Women are also more likely to suffer from anemia, osteoporosis, thyroid disorders, autoimmune diseases, and mental health issues. Cancer is notably common among women, primarily due to high rates of breast and cervical cancer. What is often not widely recognized is that postmenopausal women are particularly at risk for ischemic heart disease, obesity, and metabolic syndrome.[3,4] Women with ischemic heart disease experience relatively worse outcomes than men.[5] Globally, women face specific health concerns that begin in infancy and persist as they transition through adolescence, adulthood, and aging. Health inequity predominantly affects poorer women from low- and middle-income countries (LMICs).[1] Gender discrimination often begins early in life for females in most LMICs, where many countries report high rates of female feticide and infanticide.[6] Female children typically experience limited access to health care, higher school dropout rates, and increased domestic violence.[7] Female genital mutilation represents a particularly severe form of violence and is practiced in numerous countries for cultural reasons.[8] In many regions, early marriage among female children is prevalent, resulting in early motherhood.[9] Poorly nourished women are associated with adverse maternal outcomes and higher perinatal complications. The children born to these women are more likely to be preterm and have low birth weights, facing increased risks of poor survival and a higher burden of noncommunicable diseases later in life.[10] In many countries, the maternal mortality rate remains alarmingly high, with a global average of approximately 223 per 100,000 live births per year, ranging from 13 per 100,000 live births in high-income countries to 430 per 100,000 live births in low-income countries (LICs) in 2020. Nearly 95% of all maternal deaths occurred in LICs and LMICs, most of which could have been prevented.[11] The disparity in the health status of women from among the different countries is also evident in kidney diseases. Significant differences exist in women’s access to health care.[1] Autoimmune connective tissue diseases, such as systemic lupus erythematosus, rheumatoid arthritis, and systemic sclerosis, affect women more than men. Many of these conditions significantly contribute to the burden of kidney disease among women. Pregnancy presents a unique challenge for women and, in some cases, can increase the risk of acute kidney injury (AKI). Common causes include sepsis, antepartum, and postpartum hemorrhage. Most women recover from AKI, but a few do not regain normal kidney function and progress to chronic kidney disease (CKD). Preeclampsia and hypertension during pregnancy have multiple immediate and delayed repercussions on the health of women and their children. Women with preeclampsia or underlying CKD may give birth to preterm, low birth weight, and small-for-gestational-age babies. Survivors may have a lower number of nephrons than full-term babies, making them vulnerable to developing CKD in the future.[1] There is also gender inequity in access to dialysis. Many studies report that women undergo dialysis less frequently than men. Furthermore, women have lower rates of arteriovenous fistulae (AVF) as access points.[12] It is well-documented that women represent the most significant pool of organ donors, while the recipients are more often men. It is important to recognize, however, that some risks and inequities disproportionately affect men, and CKD progresses faster in men.[13] The situation in India seems to align closely with the global perspective. Although there is a lack of data in many areas, some key differences are evident. The multicentric Indian Chronic Kidney Disease cohort study reported a lower prevalence of CKD in women (32.8%). This study focused on hospital outpatients, so it is likely that fewer women sought medical care, and those with milder forms of kidney disease may not have reached the hospital.[14] However, the lower prevalence in women has also been observed in several community studies.[15-17] Pregnancy-related-AKI (PR-AKI) was reported to be as high as 22% in some earlier studies, but this figure has shown a declining trend over the last few decades, primarily due to improved antenatal care and a reduction in postabortion AKI.[18] Still, PR-AKI accounts for approximately 3%–5% of total AKI cases and is mainly observed during the postpartum period. Puerperal sepsis and postpartum hemorrhage are the most common causes, while preeclampsia/eclampsia is the leading cause of AKI in the third trimester.[19] It is crucial to note that maternal and fetal mortality rates remain around 25% in these studies, and only 39% of patients achieved complete recovery of renal function.[20] PR-AKI poses a risk factor for future CKD in these individuals. Patients with underlying CKD generally have lower fertility rates; however, when pregnancy occurs in a woman with CKD, the maternal and fetal outcomes are likely to be poor. In a retrospective study, Singh etal. reported a greater decline in glomerular filtration rate (GFR) in patients with advanced CKD compared to those with earlier-stage CKD (estimated GFR >60 ml/min) after delivery. The adverse maternal and fetal outcomes were more significant in women with CKD stage 3 or 4.[21] Gender inequity in dialysis has also been reported in India.[22] In a cross-sectional study of prevalent dialysis patients, the most common vascular access method was indwelling venous catheters, and AVFs were significantly more common in men.[23] Data from the National Organ and Tissue Transplant Organization confirm that most organ donors are women. Recent analysis reveals that for every 100 male donors, 192.71 male recipients benefited, while every 100 female donors supported only about 47 female recipients.[24] Women also have limited access to health care due to inadequate utilization of health insurance.[25] The future holds some promise and some as yet unanswered questions. Higher maternal age at conception, decreased fertility, and assisted reproduction are associated with more complicated pregnancies.[26] Higher rates of preeclampsia are seen with a possible increased risk of CKD. Therefore, the landscape of obstetric AKI may evolve in the future with emerging challenges. Accurate data collection is essential for understanding the extent of gender’s effects on the occurrence, distribution, and outcomes of kidney diseases in women. Currently, we have very limited data, and there are significant variations in the numbers. These discrepancies are even greater in LICs and LMICs, where a lack of modern data infrastructures can lead to missed opportunities for data capture. In addition, women are recruited less often in clinical trials. This leaves critical gaps in understanding women’s unique health needs.[1] Funding opportunities for research on women’s health should increase. Multicentric studies with pooled data are necessary to understand the regional and national variations in outcomes. Collaborations between centers, such as the Indian cohort of Pregnancy-Associated acute Kidney injury: A nationwide Network (iPRAKI-NET), is one such example.[27] There is a clear need for greater awareness, timely diagnosis, and appropriate follow-up of kidney diseases in women, including PR-AKI and CKD during pregnancy. In turn, pregnancy may also provide a valuable opportunity for the early diagnosis of CKD, allowing for the planning of therapeutic interventions. In addition, there is a need to enhance women’s participation in decision-making regarding their own health issues and empower them in this process. Societies that prioritize women’s health will likely experience better overall population health and remain more productive for generations to come.[28] Every March, as we celebrate International Women’s Day and World Kidney Day, we must commit ourselves to promoting women’s health and kidney health.
Author: Y. J. Anupama
Language: English
Topic: Sex and Gender in Healthcare
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4408975324