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Review article

Sex and gender differences in chronic kidney disease: progression to end-stage renal disease and haemodialysis

Gabriela Cobo, Manfred Hecking, Friedrich K. Port, Isabella Exner, Bengt Lindholm, Peter Stenvinkel, Juan Jesús Carrero
Clinical Science Jun 01, 2016, 130 (14) 1147-1163; DOI: 10.1042/CS20160047
Gabriela Cobo
Divisions of Renal Medicine and Baxter Novum (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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Manfred Hecking
Department of Internal Medicine III–Nephrology, Medical University of Vienna, Austria
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Friedrich K. Port
Arbor Research Collaborative for Health, Ann Arbor, MI, U.S.A.
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Isabella Exner
First Medical Department–Dialysis of Kaiser–Franz–Josef–Spital, Vienna, Austria
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Bengt Lindholm
Divisions of Renal Medicine and Baxter Novum (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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Peter Stenvinkel
Divisions of Renal Medicine and Baxter Novum (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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Juan Jesús Carrero
Divisions of Renal Medicine and Baxter Novum (CLINTEC), Karolinska Institutet, Stockholm, SwedenCentre for Molecular Medicine (MMK), Karolinska Institutet, Stockholm, Sweden
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  • For correspondence: juan.jesus.carrero@ki.se
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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.

  • anaemia
  • dialysis
  • gender medicine
  • inequalities
  • oestrogen
  • sex
  • testosterone
  • Abbreviations

    ACE,
    angiotensin-converting enzyme;
    ACEI,
    ACE inhibitor;
    ARB,
    angiotensin receptor blocker;
    AVF,
    arteriovenous fistula;
    CI,
    confidence interval;
    CKD,
    chronic kidney disease;
    CVD,
    cardiovascular disease;
    eGFR,
    estimated GFR;
    ESA,
    erythropoietin-stimulating agent;
    ESRD,
    end-stage renal disease;
    GFR,
    glomerular filtration rate;
    HRT,
    hormone replacement therapy;
    KIM-1,
    kidney injury molecule-1;
    MBD,
    mineral bone disorder;
    MDRD,
    Modification of Diet in Renal Disease;
    NO,
    nitric oxide;
    RAS,
    renin–angiotensin system;
    RTx,
    renal transplantation;
    VMS,
    vasomotor symptom
    • © 2016 The Author(s). Published by Portland Press Limited on behalf of the Biochemical Society
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    July 2016

    Volume: 130 Issue: 14

    Clinical Science: 130 (14)
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    Sex and gender differences in chronic kidney disease: progression to end-stage renal disease and haemodialysis
    Gabriela Cobo, Manfred Hecking, Friedrich K. Port, Isabella Exner, Bengt Lindholm, Peter Stenvinkel, Juan Jesús Carrero
    Clinical Science Jul 2016, 130 (14) 1147-1163; DOI: 10.1042/CS20160047
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    Sex and gender differences in chronic kidney disease: progression to end-stage renal disease and haemodialysis
    Gabriela Cobo, Manfred Hecking, Friedrich K. Port, Isabella Exner, Bengt Lindholm, Peter Stenvinkel, Juan Jesús Carrero
    Clinical Science Jul 2016, 130 (14) 1147-1163; DOI: 10.1042/CS20160047

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    • Article
      • Abstract
      • WHY CAN'T A WOMAN BE MORE LIKE A MAN?
      • KIDNEY PHYSIOLOGY
      • PROGRESSION TO END-STAGE RENAL DISEASE
      • CKD EPIDEMIOLOGY AND INITIATION OF DIALYSIS
      • HAEMODIALYSIS: OUTCOMES, PATHOPHYSIOLOGY AND MANAGEMENT
      • CONCLUSION
      • FUNDING
      • Acknowledgments
      • References
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    Keywords

    anaemia
    dialysis
    gender medicine
    inequalities
    oestrogen
    sex
    testosterone

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