Why do we keep ignoring sex in kidney disease?

Throughout the history of nephrology, little attention has been paid to the sex and gender differences in kidney disease. This lack of awareness prevents optimal diagnosis and management of kidney disease. In today's world of precision medicine, it is imperative to appreciate the differential factors regarding gender and kidney disease. This editorial summarizes the up-to-date literature regarding sex and gender differences in kidney disease and considers areas where knowledge is incomplete and where further research is needed. We address sex-specific effects on chronic kidney disease epidemiology; risks of dialysis underdosing and medication overdosing in women; unexplained loss of female sex advantage in life expectancy during dialysis, and impact of sex on diagnosis and management of genetic kidney disease. We also aim to highlight the impact of gender on kidney health and raise awareness of disparities that may be faced by women, and transgender and gender-diverse persons when a male-model approach is used by healthcare systems. By understanding the link between sex and kidney disease, kidney specialists can improve the care and outcomes of their patients. In addition, research on this topic can inform the development of targeted prevention and intervention strategies that address the specific needs and risk factors of different populations. LAY SUMMARY Until recently, the differences attributed to sex and gender have not been of interest for kidney specialists. That was an obvious omission which might result in inappropriate diagnosis and treatment. Today, as the individual approach becomes the core of medicine, factors regarding gender and kidney disease should be better acknowledged. This editorial summarizes the up-to-date literature regarding sex and gender differences in kidney disease. In addition, it shows what is not known yet and in which direction future research should be planned. Here we discuss the specific problems in diagnosis and treatment of kidney diseases. We also aim to highlight the impact of gender on kidney health and raise awareness of disparities that may be faced by women, and transgender and gender-diverse persons when a male-model approach is used by healthcare systems. Finally, we propose some solutions that may be pursued to improve clinical practice in the nearest future.