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.
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July 2016
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Sagittal section through the retina of a hypertensive dTGR rat: staining in blue (DAPI) of cell nuclei and in red GFAP (glial fibrillary acidic protein). The GFAP staining shows activated astrocytes in the ganglion cell layer of the retina. See pp. 1075–1088 for further details. Image kindly provided by Olaf Strauß.
Review Article|
June 01 2016
Sex and gender differences in chronic kidney disease: progression to end-stage renal disease and haemodialysis
Gabriela Cobo;
Gabriela Cobo
*Divisions of Renal Medicine and Baxter Novum (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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Manfred Hecking;
Manfred Hecking
†Department of Internal Medicine III–Nephrology, Medical University of Vienna, Austria
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Friedrich K. Port;
Friedrich K. Port
‡Arbor Research Collaborative for Health, Ann Arbor, MI, U.S.A.
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Isabella Exner;
Isabella Exner
§First Medical Department–Dialysis of Kaiser–Franz–Josef–Spital, Vienna, Austria
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Bengt Lindholm;
Bengt Lindholm
*Divisions of Renal Medicine and Baxter Novum (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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Peter Stenvinkel;
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, Sweden
║Centre for Molecular Medicine (MMK), Karolinska Institutet, Stockholm, Sweden
Correspondence: Juan Jesús Carrero (email [email protected]).
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Publisher: Portland Press Ltd
Received:
January 18 2016
Revision Received:
March 14 2016
Accepted:
March 29 2016
Online ISSN: 1470-8736
Print ISSN: 0143-5221
© 2016 The Author(s). Published by Portland Press Limited on behalf of the Biochemical Society
2016
Clin Sci (Lond) (2016) 130 (14): 1147–1163.
Article history
Received:
January 18 2016
Revision Received:
March 14 2016
Accepted:
March 29 2016
Citation
Gabriela Cobo, Manfred Hecking, Friedrich K. Port, Isabella Exner, Bengt Lindholm, Peter Stenvinkel, Juan Jesús Carrero; Sex and gender differences in chronic kidney disease: progression to end-stage renal disease and haemodialysis. Clin Sci (Lond) 1 July 2016; 130 (14): 1147–1163. doi: https://doi.org/10.1042/CS20160047
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