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Womenand Kidney Diseases: Questions Unanswered and Answers Unquestioned Giorgina B. Piccoli1,2, Mona Alrukhaimi3, Zhi-Hong Liu4, Elena Zakharova5,6,7 and Adeera Levin8; on behalf of the World Kidney Day Steering Committee9 1Department of Clinical and Biological Sciences, University of Torino, Italy; 2Nephrology, Centre Hospitalier Le Mans, Le Mans, France; 3Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates; 4National Clinical Research Center of Kidney Dis eases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China; 5Nephrology, Moscow City Hospital n.a. S.P. Botkin, Moscow, Russian Federation; 6Nephrology, Moscow State University of Medicine and Dentistry, Moscow, Russian Federation; 7Nephrology, Russian Medical Academy of Continuous Professional Educa tion, Moscow, Russian Federation; and 8Department of Medicine, Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada Kidney Int Rep (2018) 3, 225–235; ª World Kidney Day 2018 Steering Committee. This is an open access article under the CC BY-NC-ND license ( Chronic kidney disease (CKD) affects approximately 10% of the world’s adult population: it is within the top 20 causes of death worldwide,1 and its impact on patients and their families can be devastating. World Kidney Day and International Women’s Day in 2018 coincide, thus offering an opportunity to reflect on the importance of women’s health and Correspondence: A. Levin, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. E-mail: This article is being published in Kidney International Reports and reprinted concurrently in several journals. The arti cles cover identical concepts and wording, but vary in minor stylistic and spelling changes, detail, and length of manuscript in keeping with each journal’s style. Any of these versions may be used in citing this article. Note that all authors contributed equally to the conception, preparation, and edit ing of the manuscript. 9See Appendix for a list of Members of the World Kidney Day Steering Committee. specifically their kidney health, on the community, and the next generations; as well as to strive to be more curious about the unique aspects of kidney disease in women, so that we may apply those learnings more broadly. Girls and women, who make up approximately 50% of the world’s population, are important contrib utors to society and their families. Besides childbearing, women are essential in childrearing and contribute to sustaining family and community health. Women in the 21st century continue to strive for equity in business, commerce, and professional endeavors, while recognizing that in many situa tions, equality does not exist. In various locations around the world, access to education and medical care is not equitable among men and women; women remain underrepresented in many clinical research studies, thus limiting the evidence base on which to make recommendations to ensure the best outcomes (Figure 1). In this editorial, we focus on what we do and do not know about women’s kidney health and kid ney disease, and what we might learn in the future to improve outcomes for all. Kidney Health and Women’s Health: A Case for Optimizing Outcomes for Present and Future Generations What We Know and Do Not Know Pregnancy is a unique challenge and is a major cause of acute kid ney injury (AKI) in women of childbearing age; AKI and pre eclampsia (PE) may lead to subse quent CKD, but the entity of the risk is not completely known.2–5 CKD has a negative effect on pregnancy even at very early stages.6,7 The risks increase with CKD progression, thus posing potentially challenging ethical issues around conception and maintaining of pregnancies.6–8 We do know that PE increases the probability of hypertension and CKDin later years, but we have not evaluated a surveillance or reno protective strategy to determine whether progressive loss of kidney function can be attenuated.9–12 Specific systemic conditions such as systemic lupus erythe matosus (SLE), arthritis rheumatoid (RA), and systemic scleroderma (SS) are more likely to affect women than men. We do not know the relative contribu tion of these acute and chronic conditions on progression to end-stage renal disease (ESRD) in women. In CKD cohorts, the prevalence in women is always less than in men, and they have slower pro gression to ESRD.13–15 We do not know why and how much of this is due to differences in identifica tion of kidney impairment, Kidney International Reports (2018) 3, 225–235 225 EDITORIAL GBPicco

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Institution
UC Irvine
Course
UC Irvine

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Title
Women and Kidney Diseases: Questions Unanswered and Answers Unquestioned.

Permalink
https://escholarship.org/uc/item/8664m08c

Journal
Kidney international reports, 3(2)

ISSN
2468-0249

Authors
Piccoli, Giorgina B
Alrukhaimi, Mona
Liu, Zhi-Hong
et al.

Publication Date
2018-03-01

DOI
10.1016/j.ekir.2018.01.001

License
https://creativecommons.org/licenses/by/4.0/ 4.0

Peer reviewed




eScholarship.org Powered by the California Digital Library
University of California

, EDITORIAL




Women and Kidney Diseases: In this editorial, we focus on what
we do and do not know about
Questions Unanswered and women’s kidney health and kid-
ney disease, and what we might
Answers Unquestioned learn in the future to improve
outcomes for all.
Giorgina B. Piccoli1,2, Mona Alrukhaimi3, Zhi-Hong Liu4,
Elena Zakharova5,6,7 and Adeera Levin8; on behalf of the World
Kidney Health and Women’s
Kidney Day Steering Committee9 Health: A Case for Optimizing
1
Department of Clinical and Biological Sciences, University of Torino, Italy; 2Nephrology, Outcomes for Present and
Centre Hospitalier Le Mans, Le Mans, France; 3Department of Medicine, Dubai Medical
College, Dubai, United Arab Emirates; 4National Clinical Research Center of Kidney Dis-
Future Generations
eases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China; What We Know and Do Not
5
Nephrology, Moscow City Hospital n.a. S.P. Botkin, Moscow, Russian Federation; Know
6
Nephrology, Moscow State University of Medicine and Dentistry, Moscow, Russian Pregnancy is a unique challenge
Federation; 7Nephrology, Russian Medical Academy of Continuous Professional Educa-
tion, Moscow, Russian Federation; and 8Department of Medicine, Division of Nephrology,
and is a major cause of acute kid-
University of British Columbia, Vancouver, British Columbia, Canada ney injury (AKI) in women of
childbearing age; AKI and pre-
eclampsia (PE) may lead to subse-
Kidney Int Rep (2018) 3, 225–235; https://doi.org/10.1016/j.ekir.2018.01.001
ª World Kidney Day 2018 Steering Committee. This is an open access article under
quent CKD, but the entity of the
the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). risk is not completely known.2–5
CKD has a negative effect on
pregnancy even at very early

C hronic kidney disease (CKD)
affects approximately 10% of
the world’s adult population: it is
specifically their kidney health, on
the community, and the next
generations; as well as to strive to
stages.6,7 The risks increase with
CKD progression, thus posing
potentially challenging ethical
within the top 20 causes of death be more curious about the unique issues around conception and
worldwide,1 and its impact on aspects of kidney disease in maintaining of pregnancies.6–8 We
patients and their families can be women, so that we may apply do know that PE increases the
devastating. World Kidney Day those learnings more broadly. probability of hypertension and
and International Women’s Day in Girls and women, who make up CKD in later years, but we have not
2018 coincide, thus offering an approximately 50% of the world’s evaluated a surveillance or reno-
opportunity to reflect on the population, are important contrib- protective strategy to determine
importance of women’s health and utors to society and their families. whether progressive loss of kidney
Besides childbearing, women are function can be attenuated.9–12
essential in childrearing and Specific systemic conditions
Correspondence: A. Levin, Department of
contribute to sustaining family and such as systemic lupus erythe-
Medicine, University of British Columbia,
Vancouver, British Columbia, Canada. community health. Women in the matosus (SLE), rheumatoid
E-mail: 21st century continue to strive for arthritis (RA), and systemic
equity in business, commerce, and scleroderma (SS) are more likely
This article is being published in Kidney
International Reports and reprinted professional endeavors, while to affect women than men. We do
concurrently in several journals. The arti- recognizing that in many situa- not know the relative contribu-
cles cover identical concepts and tions, equality does not exist. In tion of these acute and chronic
wording, but vary in minor stylistic and
spelling changes, detail, and length of
various locations around the conditions on progression to
manuscript in keeping with each journal’s world, access to education and end-stage renal disease (ESRD) in
style. Any of these versions may be used medical care is not equitable women.
in citing this article.
among men and women; women In CKD cohorts, the prevalence
Note that all authors contributed equally remain underrepresented in many in women is always less than in
to the conception, preparation, and edit- clinical research studies, thus men, and they have slower pro-
ing of the manuscript. limiting the evidence base on gression to ESRD.13–15 We do not
9 which to make recommendations know why and how much of this
See Appendix for a list of Members
of the World Kidney Day Steering to ensure the best outcomes is due to differences in identifica-
Committee. (Figure 1). tion of kidney impairment,
Kidney International Reports (2018) 3, 225–235 225

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