Women's Kidney Health in Focus: A Scientific Statement From the American Heart Association

Chronic kidney disease is a global epidemic affecting ≈10% of adults worldwide. Women have a higher prevalence of chronic kidney disease than men yet are less likely to progress to kidney failure, to initiate dialysis, or to receive a kidney transplantation, underscoring the influence of biological sex on chronic kidney disease development, progression, treatment response, and outcomes. Women may also respond differently from men to pharmacological therapies, but they remain underrepresented in clinical trials, limiting the evidence base for sex-specific kidney care. Preclinical evidence implicates a role for estrogen receptor signaling in renal physiology and pathophysiology. Women with chronic kidney disease are at increased risk for adverse pregnancy outcomes and hypertensive disorders of pregnancy, and pregnancy complications can also increase future chronic kidney disease risk. Menopause and aging accelerate chronic kidney disease progression in women as a result of declining estradiol and shifts in kidney estrogen receptor profiles. Endocrine and metabolic disorders such as polycystic ovary syndrome increase susceptibility to chronic kidney disease. Family planning, prepregnancy counseling, and antenatal care are essential to support reproductive health in women with chronic kidney disease. Because chronic kidney disease and cardiovascular disease are tightly intertwined, chronic kidney disease is also a leading contributor to cardiovascular mortality in women. Advancing precision kidney medicine for women requires equitable access to kidney care, embedding assessment of reproductive health in chronic care, trial design with adequate power that includes both women and men, and mechanistic studies linking reproductive health to long-term cardiovascular disease and chronic kidney disease development and progression.