Sex-specific differences in the epidemiology, progression, and outcomes of chronic kidney disease

Abstract

Higher prevalence of chronic kidney disease (CKD) in women than in men was reported all over the world. This difference could be partly explained by longer life expectancy and slower CKD progression rate in women. Potential factors associated with sex difference in CKD progression are: difference in glomerular hemodynamic and the response to angiotensin II; sex hormones - estrogen has protective but testosterone deleterious effects on CKD progression; lifestyle. In most countries, the percentage of men is higher than women among incident and prevalent patients on hemodialysis (HD). In HD patients the index Kt/V overestimates HD adequacy, secondary hyperparathyroidism is more common in women, and women require higher doses of erythropoiesis stimulating agents for achieving and maintaining the hemoglobin target level. The survival of HD patients is equal for both sexes. In earlier years, an equal percentage of women and men started peritoneal dialysis (PD), but in recent years, a higher percentage of women, especially at younger ages, start PD. Initial peritoneal transport properties differ between men and women. A smaller percentage of women than men receive deceased donor kidneys but women are more likely to be living kidney donors. Kidney allograft outcome depends on the sex and age of both the recipient and the donor. Cardiovascular diseases are the most common cause of death for renal replacement therapy patients of both sexes. Although sex-specific differences have been described in CKD patients, the inequality of patients in access to medical care has not been found in most regions of the world.