Chronic kidney disease (CKD) affects about 1 in 10 women worldwide, but diagnosis is frequently delayed, and women are less likely to receive dialysis or a kidney transplant compared to men, according to a new American Heart Association scientific statement published in the journal Circulation. The statement, “Women’s Kidney Health in Focus,” outlines seven key challenges women face in kidney care and offers strategies to advance kidney health for women.
“Many cases go undiagnosed in women because common tests and research do not always reflect women’s biology and life stages,” said Eman Y. Gohar, Ph.D., M.S., FAHA, chair of the statement writing group. “Biological differences include genetics, sex chromosomes, hormones, immune-system responses and differences in how the body processes and responds to medication.” Gohar also emphasized female-specific factors such as menstrual health, pregnancy, postpartum changes, and menopause, as well as socioeconomic barriers like financial constraints and cultural expectations.
The statement points out that kidney function is commonly estimated using creatinine, a waste product generated by muscle. Because women typically have less muscle mass and may produce less creatinine, these estimates can misclassify or delay recognition of kidney disease in women. This can lead to delayed referrals for specialist care.
Women also remain underrepresented in clinical trials for CKD, limiting understanding of how treatments affect them differently. “Women are not simply smaller versions of men,” Gohar said. “Their biology, reproductive life stages and responses to medication may differ, and those differences need to be reflected in clinical care and research.” Laboratory research suggests estrogen receptors may play a role in kidney function, and differences in drug absorption, distribution, metabolism, and excretion can lead to varying responses.
Kidney and reproductive health are closely connected. Pregnancy in women with CKD may increase the risk of disease progression and complications. In women without CKD, pregnancy complications such as preeclampsia may signal increased risk of future kidney disease, heart disease, and stroke. Natural menopause before age 45 and surgical removal of the ovaries before age 50 are each linked with a higher risk of CKD. Polycystic ovary syndrome and lupus are also associated with higher CKD risk.
Access to timely care remains a significant gap. Women tend to begin dialysis at a lower level of kidney function than men, indicating delayed treatment initiation. Globally, men receive kidney transplants about 30% more often than women, and in some low- and middle-income countries, the gap exceeds 10-to-1. Poverty, limited health literacy, caregiving responsibilities, cultural expectations, limited support, and treatment costs further delay diagnosis or make specialist care harder to reach.
CKD is a major contributor to heart disease and stroke risk, which is why it is part of cardiovascular-kidney-metabolic (CKM) syndrome. Diabetes, another component of CKM syndrome, is the leading cause of CKD worldwide, and some evidence suggests women with diabetes may progress to kidney failure at higher rates than men.
To improve kidney care for women, the statement recommends embedding reproductive health assessment in CKD care, increasing women’s enrollment in clinical trials, conducting sex-specific analyses of study findings, and further studying how female biology and life stages affect kidney function and treatment effects. These steps are critical for advancing precision medicine and reducing disparities in kidney care.
The implications for patients and the health care industry are profound. Earlier diagnosis and tailored treatment could prevent or delay kidney failure, reduce cardiovascular complications, and improve quality of life for millions of women. For clinicians, incorporating reproductive history and sex-specific considerations into routine CKD care may become standard practice. For researchers, the call for greater inclusion of women and sex-based analysis could reshape trial design and regulatory requirements. As the statement is a scientific advisory rather than a clinical guideline, it does not make treatment recommendations but aims to raise awareness and guide future research priorities.
