Sex and gender disparities in the epidemiology and outcomes of chronic kidney disease

Key Points The proportion of women with predialysis chronic kidney disease (CKD) is higher than that of men; this difference is likely due to the longer life expectancy of women and possibly to CKD overdiagnosis with use of estimated glomerular filtration rate equations Kidney function declines faster in men than women, possibly owing to unhealthier lifestyles in men and the protective effects of oestrogens or the damaging effects of testosterone More men than women start renal replacement therapy (RRT) not only owing to faster CKD progression in men but also because elderly women are more likely to choose conservative care Mortality is higher among men at all levels of predialysis CKD, whereas mortality among individuals on RRT is similar for men and women Women have reduced access to deceased donor transplantation compared with men, likely owing to higher levels of preformed antibodies, whereas access to living donor kidney transplantation in some countries seems equal The perceived health-related quality of life of women on RRT is poorer than that of men, and women report a higher symptom burden and greater symptom severity than men