Women and kidney health: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Abstract

The KDIGO (Kidney Disease: Improving Global Outcomes) Controversies Conference on Women and Kidney Health was convened to identify key sex and gender issues in kidney care, practices for optimizing healthcare in women with kidney diseases, and priorities for future research. Participants emphasized the importance of addressing the influence of sex and gender in diagnosis, risk assessment, prognosis, and treatment of chronic kidney disease (CKD) and its complications, as well as considering issues across the lifespan (puberty, sexual and reproductive health, menopause). CKD is a risk factor for adverse pregnancy outcomes with every type of kidney disease and severity. All women of reproductive age known to have CKD should be counseled on contraception, the ideal timing of pregnancy, the risks and outcomes for mother and fetus, fertility treatments where these are available, medication management, and medical aspects of pregnancy termination. A successful pregnancy is possible across all severities of CKD, including in women living with dialysis or a kidney transplant. Pregnancy should be managed with a multidisciplinary care plan based upon the type of kidney disease and the presence and severity of kidney function impairment, hypertension, and proteinuria. Systematic assessment of blood pressure, proteinuria, and kidney function in all pregnancies would facilitate diagnosis of CKD and detection of acute kidney injury (AKI). Follow-up programs for women who experienced pregnancy-related AKI, preeclampsia, or other hypertensive disorders of pregnancy are important as these conditions may reflect undiagnosed CKD and have important implications for future cardiovascular health.

Keywords: acute kidney injury; chronic kidney disease; female; hypertensive disorders of pregnancy; preeclampsia; reproductive health; women.