American Heart Association Statement Highlights Gaps in Women's Kidney Care

Chronic kidney disease (CKD) affects approximately 1 in 10 women worldwide, but women are less likely than men to receive timely diagnosis and critical treatments such as dialysis or a kidney transplant, according to a new American Heart Association scientific statement published in the Association's flagship journal Circulation. The statement, titled "Women's Kidney Health in Focus," outlines seven key challenges women face in kidney care and offers strategies to improve outcomes.

"Many cases go undiagnosed in women because common tests and research do not always reflect women's biology and life stages," said Eman Y. Gohar, Ph.D., M.S., FAHA, volunteer chair of the scientific statement writing group. Gohar, an assistant professor of medicine at Vanderbilt University Medical Center in Nashville, Tennessee, emphasized that biological differences—including genetics, sex chromosomes, hormones, and immune-system responses—along with female-specific factors like menstrual health, pregnancy, postpartum changes, and menopause, require tailored care approaches.

The statement identifies several systemic issues: women are underrepresented in clinical trials, have less access to treatment, experience delayed referrals, face adverse pregnancy outcomes, and encounter more adverse effects from kidney medications. Women also begin dialysis at a lower level of kidney function compared to men and are less likely to receive a kidney transplant. Globally, men receive kidney transplants about 30% more often than women; in some low- and middle-income countries, the gap exceeds 10-to-1.

Kidney function is commonly estimated using creatinine, a waste product generated by muscle. Because women typically have less muscle mass, these estimates may misclassify or delay recognition of kidney disease. "Women are not simply smaller versions of men," Gohar said. "Their biology, reproductive life stages and responses to medication may differ, and those differences need to be reflected in clinical care and research."

The statement also highlights the close connection between kidney and reproductive health. Pregnancy in women with CKD may increase the risk of disease progression and complications, while pregnancy complications like preeclampsia in women without CKD may signal future kidney and heart disease. Natural menopause before age 45 and surgical ovary removal before age 50 are each linked to higher CKD risk. Conditions such as polycystic ovary syndrome and lupus are also associated with increased CKD risk in women.

CKD is a major contributor to heart disease and stroke risk, forming part of cardiovascular-kidney-metabolic (CKM) syndrome. Diabetes, another component of CKM syndrome, is the leading cause of CKD worldwide, and some evidence suggests women with diabetes may progress to kidney failure at higher rates than men.

To address these disparities, the statement recommends embedding reproductive health assessments into CKD care, increasing women's enrollment in clinical trials, conducting sex-specific analyses of study findings, and further researching how female biology and life stages affect kidney function and treatment responses. These steps aim to advance precision medicine and reduce gaps in care.

The scientific statement was prepared by a volunteer writing group on behalf of the American Heart Association's Kidney in Cardiovascular Disease Committee. While scientific statements inform guideline development, they do not make treatment recommendations. The Association receives more than 85% of its revenue from sources other than corporations, including contributions from individuals, foundations, and estates, and maintains strict policies to prevent donations from influencing its science.

For Texas, where diabetes and cardiovascular disease are prevalent, these findings underscore the need for heightened awareness and equitable kidney care. As the state's population grows and ages, addressing sex-specific factors in CKD could reduce the burden on patients and the healthcare system, ultimately saving lives and improving quality of life for women across the state.