title: Sex and gender differences in chronic kidney disease: progression to end-stage renal disease and haemodialysis.
abstract: Sex and gender differences are of fundamental importance in most diseases, including chronic kidney disease (CKD). Men and women with CKD differ with regard to the underlying pathophysiology of the disease and its complications, present different symptoms and signs, respond differently to therapy and tolerate/cope with the disease differently. Yet an approach using gender in the prevention and treatment of CKD, implementation of clinical practice guidelines and in research has been largely neglected. The present review highlights some sex- and gender-specific evidence in the field of CKD, starting with a critical appraisal of the lack of inclusion of women in randomized clinical trials in nephrology, and thereafter revisits sex/gender differences in kidney pathophysiology, kidney disease progression, outcomes and management of haemodialysis care. In each case we critically consider whether apparent discrepancies are likely to be explained by biological or psycho-socioeconomic factors. In some cases (a few), these findings have resulted in the discovery of disease pathways and/or therapeutic opportunities for improvement. In most cases, they have been reported as merely anecdotal findings. The aim of the present review is to expose some of the stimulating hypotheses arising from these observations as a preamble for stricter approaches using gender for the prevention and treatment of CKD and its complications.
authors.affiliation: Divisions of Renal Medicine and Baxter Novum (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Cobo
authors.affiliation: Department of Internal Medicine III-Nephrology, Medical University of Vienna, Austria.
authors.forename: Manfred
authors.initials: M
authors.lastname: Hecking
authors.affiliation: Arbor Research Collaborative for Health, Ann Arbor, MI, U.S.A.
authors.forename: Friedrich K
authors.initials: FK
authors.lastname: Port
authors.affiliation: First Medical Department-Dialysis of Kaiser-Franz-Josef-Spital, Vienna, Austria.
authors.forename: Isabella
authors.initials: I
authors.lastname: Exner
authors.affiliation: Divisions of Renal Medicine and Baxter Novum (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
authors.forename: Bengt
authors.initials: B
authors.lastname: Lindholm
authors.affiliation: Divisions of Renal Medicine and Baxter Novum (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Stenvinkel
authors.affiliation: Divisions of Renal Medicine and Baxter Novum (CLINTEC), Karolinska Institutet, Stockholm, Sweden Centre for Molecular Medicine (MMK), Karolinska Institutet, Stockholm, Sweden juan.jesus.carrero@ki.se.
authors.forename: Juan Jesús
authors.initials: JJ
authors.lastname: Carrero
mesh_terms: D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000502:physiology; D007676:Kidney Failure, Chronic / Q000209:etiology* / Q000628:therapy; D008297:Male; D009569:Nitric Oxide / Q000378:metabolism; D018384:Oxidative Stress; D011388:Prolactin / Q000502:physiology; D016032:Randomized Controlled Trials as Topic; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D012727:Sex Characteristics; D012959:Socioeconomic Factors
chemical_list: D009569:Nitric Oxide; D011388:Prolactin
keywords: anaemia; dialysis; gender medicine; inequalities; oestrogen; sex; testosterone