This year on the 8th March, World Kidney Day coincided with International Women’s Day. With chronic kidney disease affecting 195 million women worldwide, the chosen theme ‘Kidneys & Women’s Health: Include, Value, Empower’ only feels apt.
Despite playing a vital role in the body maintaining homeostasis, kidney health is often overlooked by many of us, and if neglected could lead to serious health implications for both men and women.
Many substances housed in the body, either from food or metabolism, can become toxic and need to be removed. The kidneys clean approximately 200 litres of blood a day of excess salts, urea, and other waste products. To do this they require a stable, constant blood pressure. Angiotensin is a peptide hormone, whose release is stimulated by the kidneys and restores normal pressure levels by constricting blood vessels. As fluid intake varies over time, it is essential the kidneys also maintain the body’s appropriate electrolyte (sodium and potassium) and water balance. This vast scope of responsibilities makes the kidneys vulnerable to complications – and even though we are able to live with just one healthy kidney, these could be critical.
Chronic kidney disease (CKD) is defined by a gradual loss of function over time and is typically caused by other long-term illnesses that increase burden on the kidneys, such as high blood pressure, diabetes, and high cholesterol. Most people can lead a normal life, showing no signs of symptoms. In the latter, more progressed stages of the disease however, these appear and normal function is considerably reduced. Acute kidney injury (AKI) is similar in terms of symptoms but is more likely to be caused by a specific event.
CKD is not limited to a particular demographic, but is more likely to develop in women and especially prevalent in people with Asian, African, or other ethnic minority backgrounds. In many less developed countries in these regions, there is a huge disparity regarding access to healthcare between genders, and so women tend to be the worst affected. This does not only apply to developing countries however; in the United States it is estimated that women pay $90k per capita more in healthcare costs and receive a lower standard of treatment compared to men. Global population is nearly 50% women and their health should be handled with as much priority as males, not only for their benefit but for humanity and future generations.
For females, poor well-being can not only affect the individual but also that of her child. Studies have shown that CKD can be associated with growth restraints in babies. Decreased kidney function can affect fertility rates and a 20% kidney functionality rate can make it almost impossible to conceive. Women with pre-existing CKD before pregnancy may further lose function and require dialysis for blood filtration. The relationship between pregnancy and CKD is complicated and varies between patients. In some instances, kidney diseases may cause miscarriages; however there is evidence to suggest that for women with mild forms of the disease, no effect is seen and they are still able to have healthy pregnancies.
Pre-eclampsia is a condition that some women experience during pregnancy that includes increased urine protein levels and high blood pressure. Whilst having pre-eclampsia is a risk factor for AKI and CKD in itself, women who have had the condition in the past are also at a five times increased of developing end stage renal disease (ESRD). This is where the kidneys are not able to function as they should and the only options are either dialysis or transplant. Women are more likely to be a living donor than to receive a transplant and begin dialysis later than men. Although oestrogen is thought to have a protective effect against ESRD until menopause, it remains unclear whether this difference is due to biological characteristics of the disease or socio-economic factors.
Lupus nephritis is kidney inflammation caused by autoimmune disease, Systemic Lupus Erythematosus (SLE), affecting eight times as many women than men. 10-30% of all patients with lupus will experience kidney failure and if not controlled may require dialysis.
Women are more susceptible to various kidney diseases mentioned above but the value of our kidneys is not superior for any gender. As with any health issue, it matters greatly to the individual patient. But what should be reinforced is that it matters no more or no less whether you are male or female.
The term ‘empower’ is defined as ‘Make (someone) stronger and more confident, especially controlling their life and claiming their rights.’ When we think of how to do this, healthcare doesn’t initially spring to mind. Gender bias and other social norms can further add to biological risk factors and put women at a much higher risk of kidney disease. If we can’t rule out biological differences we should at least aim to reduce the various socio-economic factors that contribute to this disparity. By understanding the value of health to women and in this instance, the importance of kidney health, we can empower through knowledge and broaden access to care and better informed decisions.
Featured image credit: Hospital by sasint. CC0 Creative commons via Pixabay.