World Kidney Day, which is a global campaign aimed at raising awareness on the importance of kidneys, is going to be celebrated on March 8. Ever since its inception in 2006, it has been observed on the second Thursday of March with a special theme for the year and this time it is centred on “Kidneys and Women’s Health”. There is a need to address and educate the population on the dangers of Chronic Kidney Disease (CKD).
It is a progressive loss of kidney function over a period of months or years. The kidneys, which are responsible for filtering the blood of the body, have about a million tiny filters called nephrons. These stop working once they get damaged, which in turn affects the process of blood filtering. When this function falls down to a certain point, the kidneys stop working, which we commonly address as kidney failure.
Chronic kidney disease (CKD) is a worldwide public health problem with adverse outcomes of kidney failure and premature death. 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. The risk of developing CKD is at least as high in women as in men, and may even be higher. According to some studies, CKD is more likely to develop in women compared with men, with an average 14% prevalence in women and 12% in men. However, the number of women on dialysis is lower than the number of men. At least three major reasons are recognized so far: CKD progression is slower in women compared to men, psycho-socioeconomic barriers such as lower disease awareness lead to late or no start of dialysis among women. And uneven access to care is a major issue in countries with no universal access to healthcare. Kidney transplantation is also unequally spread, mostly due to social, cultural and psychological aspects: even in some countries that provide kidney transplantation and equitable treatment for men and women, women tend more often to donate kidneys and are less likely to receive them. There is indeed a clear need to address issues of equitable healthcare access for women where it is currently lacking and increase awareness and education to facilitate women’s access to treatment and better health outcomes.
Some kidney diseases, such as lupus nephropathy or kidney infection (acute or chronic pyelonephritis) typically affect women. Lupus nephritis is a kidney disease caused by an autoimmune disease, which is a disorder in which the body’s immune system attacks the own cells and organs . Pyelonephritis is a potentially severe infection that involves one or both kidneys . Kidney infections (as most urinary tract infections) are more common in women and the risk increases in pregnancy. To ensure good results, as most renal diseases, diagnosis and treatment should be timely.
CKD is also considered a risk factor for adverse pregnancy outcome and reduced fertility. Women who have CKD are at increased risk for negative outcomes for the mother and the baby; pregnancies in women with advanced CKD are most challenging with high rates of hypertensive disorders and preterm births. They may have reduced fertility but conception is possible, even if infrequent, on dialysis. On dialysis, results improve with intensive (daily or nearly daily) dialysis treatment, thus calling for dedicated programs for women of childbearing age.
In successfully transplanted women, fertility can be restored and chances of successful birth increase. However, as complications are observed more often than in the general population, preconception medical counseling should always be sought. There is a clear need for higher awareness on CKD in pregnancy, to timely identify 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, characterised by hypertension and proteinuria (protein in urine), is one of the 3 leading causes of maternal mortality. Pre-eclampsia, septic abortion 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.
The burden of those pregnancy related complications is particularly high for women in developing countries due to insufficient access to universal and timely prenatal care, to improper management of women with pre-eclampsia, and to lack of availability of dialysis for kidney failures.What are the objectives of World Kidney Day?
The joint initiative of the International Society of Nephrology (ISN) and the International Federation of Kidney Foundations (IFKF) aims at:
* Highlighting diabetes and high blood pressure as key risk factors for Chronic Kidney Disease.
* Encouraging systematic screening of all patients with diabetes and hypertension for CKD.
* Educating about the preventive behaviours.
* Encouraging transplantation as a best-outcome option for kidney failure, and the act of organ donation as a life-saving initiative.