Why the study?
Women have a higher prevalence of chronic kidney disease than men but are less likely to progress to kidney failure or receive kidney transplantation, highlighting sex differences in disease development, progression, treatment response, and outcomes.
This AHA scientific statement highlights the unique aspects of women's kidney health, emphasizing the need for sex-specific kidney care, equitable access, and integration of reproductive health in chronic care to mitigate cardiovascular and kidney disease risks.
Answers are grounded in this paper and cite their sources.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Many cases go undiagnosed in women because common tests and research do not always reflect women's biology and life stages. Biological differences include genetics, sex chromosomes, hormones, immune-system responses and differences in how the body processes and responds to medication. We also need to acknowledge female-specific factors that do not apply in the same way to male patients. These include menstrual health, pregnancy, postpartum changes and menopause, as well as socioeconomic factors like financial barriers or cultural expectations. Each of these creates considerations that are unique to women and may require tailored care.”
“This is a topic that is really close to my heart because it's focused on women's kidney health. So the fact that we are paying more attention to women's kidney health and it's coming from AHA, it's huge.”
Sex-specific CKD care incorporating reproductive health should be considered now; extends evidence synthesis to guide equitable cardiovascular-kidney research.
Chronic kidney disease is a global epidemic affecting ≈10% of adults worldwide. Women have a higher prevalence of chronic kidney disease than men yet are less likely to progress to kidney failure, to initiate dialysis, or to receive a kidney transplantation, underscoring the influence of biological sex on chronic kidney disease development, progression, treatment response, and outcomes. Women may also respond differently from men to pharmacological therapies, but they remain underrepresented in clinical trials, limiting the evidence base for sex-specific kidney care. Preclinical evidence implicates a role for estrogen receptor signaling in renal physiology and pathophysiology. Women with chronic kidney disease are at increased risk for adverse pregnancy outcomes and hypertensive disorders of pregnancy, and pregnancy complications can also increase future chronic kidney disease risk. Menopause and aging accelerate chronic kidney disease progression in women as a result of declining estradiol and shifts in kidney estrogen receptor profiles. Endocrine and metabolic disorders such as polycystic ovary syndrome increase susceptibility to chronic kidney disease. Family planning, prepregnancy counseling, and antenatal care are essential to support reproductive health in women with chronic kidney disease. Because chronic kidney disease and cardiovascular disease are tightly intertwined, chronic kidney disease is also a leading contributor to cardiovascular mortality in women. Advancing precision kidney medicine for women requires equitable access to kidney care, embedding assessment of reproductive health in chronic care, trial design with adequate power that includes both women and men, and mechanistic studies linking reproductive health to long-term cardiovascular disease and chronic kidney disease development and progression.
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Gohar et al. (2026) conducted a review in Chronic kidney disease. Female sex vs. Male sex was evaluated. Biological sex influences chronic kidney disease progression and outcomes, with women having a higher prevalence but lower rates of progression to kidney failure compared to men.
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