This year’s World Kidney Day, on the same day as International Women’s Day (Thursday 8 March) highlighted how women are more likely to donate kidneys than men, and also more likely to suffer from the most serious stages of chronic kidney disease (CKD), mainly because they tend to live longer than men with serious CKD and take longer to reach a critical stage requiring transplantation.
World Kidney Day (organised by the International Society of Nephrology and the International Federation of Kidney Foundations) also highlighted the huge challenges faced by women with CKD who want to have a baby. Despite of a higher risk of preterm delivery and of preeclampsia and related conditions, conception is possible even on dialysis. In these cases, daily dialysis is often required to ensure a successful pregnancy, with most dialysis able to take place safely at home using home-based dialysis equipment. Unfortunately, providing intensified dialysis in emerging countries is not always possible in hospital or at home, due to limited infrastructure and prohibitive out-of-pocket expenses.
Data from Europe show that 36% of women that are clinically suitable go on to donate a kidney to their husband. However, only 7% of clinically suitable men go on to donate a kidney for their wife. “Although it is hard to pinpoint a specific reason for higher numbers of wives being donors than husbands, the evidence suggests women are motivated by reasons such as altruism and the desire to help their family continue to survive,” says ISN immediate Past President Professor Adeera Levin, a Professor of Medicine at the University of British Colombia, Vancouver, BC, Canada.
Across high-income countries, available data also shows that 60-65% of kidney transplant recipients are men. Most of this difference is due to living donation, usually from a woman of the family. Thus while men are much more likely to receive a kidney than women, they are less likely to donate one themselves while alive. However, when looking at deceased donors, the difference between deceased men and women donating kidneys appears much smaller. Of course, this is not to say that men do not donate kidneys, it just means that they are less likely to than women.
Available data suggests the rate of CKD in women, 14%, is slightly higher than in men (12%). While there are more men than women on dialysis (the reasons for this are not fully understood), data from different countries show that higher proportions of women live with advanced CKD. While there are specific conditions unique to women that could explain some of this difference, including higher rates of renal infections and autoimmune disease (such as lupus nephropathy), experts believe that systemic failures to detect or manage CKD in women leave women at a higher risk of progression and complications.
“In women who have had a successful kidney transplant, fertility can be at least partly restored and chances of successful birth increase,” says Dr Giorgina Piccoli, ISN pregnancy in CKD expert, based at the University of Torino, Italy, and Centre Hospitalier Le Mans, France. “However, complications in these women remain more common than in the general population, and preconception medical counselling should always be sought. There is a clear need for higher awareness of CKD in pregnancy, to timely identify CKD in pregnancy, and to follow-up women with CKD during and after pregnancy. When a woman becomes pregnant may be also a valuable occasion for early diagnosis of CKD, thus allowing planning of therapeutic interventions.”
“Women face unique issues in relation to kidney disease and donation, and since this year’s World Kidney Day coincides with International Women’s Day, we decided now was the time to highlight these issues,” concludes Professor Levin.