Chronic Kidney Disease (CKD) in women

Dr Sanjeev Gulati *

Chronic kidney disease (CKD) affects 15-20 % of the India's adult population and is one of the top 20 causes of death worldwide . It is a disease which impacts not only the patients but their entire family with devastating economic consequences. Girls and women, who make up 48% of the Indian population and are important contributors to society and their families. Women have unique risks for kidney diseases. Kidney diseases and issues related to access to care have a profound impact on both the current and next generations.

CKD affects approximately 195 million women worldwide and it is currently the 8th leading cause of death in women, with close to 600,000 deaths each year. In some studies the risk of developing CKD has been reported to be higher in women than men. Also there are certain diseases like Lupus Nephropathy and Chronic Pyleonephritis which are unique to women .

CKD is also considered a risk factor for adverse pregnancy outcome and reduced fertility. Women who have CKD are at increased risk for poorer outcomes both for the mother and the baby; pregnancies in women with advanced CKD are more difficult to manage with higher rates of hypertensive disorders and preterm births. There is a clear need for higher awareness on CKD in pregnancy, early diagnosis of CKD in pregnancy, and to follow-up women with CKD during and after pregnancy.

In this respect, pregnancy may be also a valuable occasion for early diagnosis of CKD, thus allowing planning of therapeutic interventions.

In turn, pregnancy-related complications increase the risk of kidney disease: pre-eclampsia, a syndrome in which a defect of the implantation of the placenta affects normal kidneys inducing hypertension and proteinuria, is one of the 3 leading causes of maternal mortality.

Diseases like Preeclampsia, septic abortion (infection of the placenta) and post-partum haemorrhage (severe bleeding after giving birth) are leading causes of acute kidney injury (AKI) in young women, and may herald future CKD in survivors Kidney transplantation is also unequally spread, mostly due to social, cultural and psychological aspects.

In India the national figures show that 70 -80% of the patients are males whereas 70- 80% of the donors are females. However things are changing since the last few years and our last years data at Fortis Insitute of Renal sciences and Transplant, Vasant Kunj shows that males constitute 67 % of the patients and 56% of the donors are females.

Advocating for improved access to care for women is critical to maintain the health of families, communities and populations.

There is a clear need for creating greater awareness, early diagnosis and regular follow-up of CKD in pregnancy.

This year World Kidney Day and International Women's Day 2018 are commemorated on the same day, giving us an opportunity to highlight the importance of women's health and particularly their kidney health. A lot has been done but a lot more needs to be done and we Nephrologists clearly have miles to go before we sleep and miles to go before we sleep.