Chronic Kidney Disease affects approximately 10% of the world’s adult population: it is within the top 20 causes of death worldwide, 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 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 contributors to society and their families. Gender differences continue to exist around the world in access to education, medical care, and participation in clinical studies. Pregnancy is a unique state for women, offering an opportunity for diagnosis of kidney disease, but also a state where acute and chronic kidney diseases may manifest, and which may impact future generations with respect to kidney health. There are various autoimmune and other conditions that are more likely to impact women with profound consequences for child bearing, and on the fetus. Women have different complications on dialysis than men, and are more likely to be donors than recipients of kidney transplants.
In this editorial, we focus on what we do and do not know about women, kidney health, and kidney disease, and what we might learn in the future to improve outcomes worldwide.
2. von Dadelszen P, Payne B, Li J, Ansermino JM, Broughton Pipkin F, Côté A-M, et al. Prediction of adverse maternal outcomes in preeclampsia: development and validation of the fullPIERS model. Lancet. 2011 Jan 15;377(9761):219–27.
3. Mol BWJ, Roberts CT, Thangaratinam S, Magee LA, de Groot CJM, Hofmeyr GJ. Pre-eclampsia. Lancet. 2016 Mar 5;387(10022):999–1011.
4. Vikse BE, Irgens LM, Leivestad T, Skjaerven R, Iversen BM. Preeclampsia and the risk of end-stage renal disease. N Engl J Med. 2008 Aug 21;359(8):800–9.
5. Theilen LH, Fraser A, Hollingshaus MS, Schliep KC, Varner MW, Smith KR, et al. All-Cause and Cause-Specific Mortality After Hypertensive Disease of Pregnancy. Obstet Gynecol. 2016 Aug;128(2):238–44.
6. Piccoli GB, Cabiddu G, Attini R, Vigotti FN, Maxia S, Lepori N, et al. Risk of Adverse Pregnancy Outcomes in Women with CKD. J Am Soc Nephrol. 2015 Aug;26(8):2011–22.
7. Zhang J-J, Ma X-X, Hao L, Liu L-J, Lv J-C, Zhang H. A Systematic Review and Meta-Analysis of Outcomes of Pregnancy in CKD and CKD Outcomes in Pregnancy. Clin J Am Soc Nephrol. 2015 Nov 6;10(11):1964–78.
8. Alkhunaizi A, Melamed N, Hladunewich MA. Pregnancy in advanced chronic kidney disease and end-stage renal disease. Curr Opin Nephrol Hypertens. 2015 May;24(3):252–9.
9. Piccoli GB, Cabiddu G, Castellino S, Gernone G, Santoro D, Moroni G, et al. A best practice position statement on the role of the nephrologist in the prevention and follow-up of preeclampsia: the Italian study group on kidney and pregnancy. J Nephrol. 2017 Jun;30(3):307–17.
10. Liu Y, Ma X, Zheng J, Liu X, Yan T. Pregnancy outcomes in patients with acute kidney injury during pregnancy: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2017 Jul 18;17(1):235.
11. Jim B, Garovic VD. Acute Kidney Injury in Pregnancy. Semin Nephrol. 2017 Jul;37(4):378–85.
12. Acharya A. Management of Acute Kidney Injury in Pregnancy for the Obstetrician. Obstet Gynecol Clin North Am. 2016 Dec;43(4):747–65.
13. Iseki K. Gender differences in chronic kidney disease. Kidney International. 2008 Aug 2;74(4):415–7.
14. Nitsch D, Grams M, Sang Y, Black C, Cirillo M, Djurdjev O, et al. Associations of estimated glomerular filtration rate and albuminuria with mortality and renal failure by sex: a meta-analysis. BMJ. 2013 Jan 29;346:f324.
15. Levin A, Djurdjev O, Beaulieu M, Er L. Variability and risk factors for kidney disease progression and death following attainment of stage 4 CKD in a referred cohort. Am J Kidney Dis. 2008 Oct;52(4):661–71.
16. Weiner DE, Tighiouart H, Elsayed EF, Griffith JL, Salem DN, Levey AS, et al. The Framingham predictive instrument in chronic kidney disease. J Am Coll Cardiol. 2007 Jul 17;50(3):217–24.
17. Oladapo OT, Adetoro OO, Ekele BA, Chama C, Etuk SJ, Aboyeji AP, et al. When getting there is not enough: a nationwide cross-sectional study of 998 maternal deaths and 1451 near-misses in public tertiary hospitals in a low-income country. BJOG. 2016 May;123(6):928–38.
18. Tranquilli AL, Dekker G, Magee L, Roberts J, Sibai BM, Steyn W, et al. The classification, diagnosis and management of the hypertensive disorders of pregnancy: A revised statement from the ISSHP. Pregnancy Hypertens. 2014 Apr;4(2):97–104.
19. Liu Y, Bao H, Jiang Z, Huang Y, Wang N. Pregnancy-related Acute Kidney Injury and a Review of the Literature in China. Intern Med. 2015;54(14):1695–703.
20. Prakash J, Pant P, Prakash S, Sivasankar M, Vohra R, Doley PK, et al. Changing picture of acute kidney injury in pregnancy: Study of 259 cases over a period of 33 years. Indian J Nephrol. 2016 Aug;26(4):262–7.
21. Ibarra-Hernández M, Orozco-Guillén OA, de la Alcantar-Vallín ML, Garrido-Roldan R, Jiménez-Alvarado MP, Castro KB, et al. Acute kidney injury in pregnancy and the role of underlying CKD: a point of view from México. J Nephrol. 2017 Oct 11.
22. Blázquez A, García D, Rodríguez A, Vassena R, Figueras F, Vernaeve V. Is oocyte donation a risk factor for preeclampsia? A systematic review and meta-analysis. J Assist Reprod Genet. 2016 Jul;33(7):855–63.
23. O’Gorman N, Wright D, Poon LC, Rolnik DL, Syngelaki A, de Alvarado M, et al. Multicenter screening for pre-eclampsia by maternal factors and biomarkers at 11-13 weeks’ gestation: comparison with NICE guidelines and ACOG recommendations. Ultrasound Obstet Gynecol. 2017 Jun;49(6):756–60.
24. Zeisler H, Llurba E, Chantraine F, Vatish M, Staff AC, Sennström M, et al. Predictive Value of the sFlt-1:PlGF Ratio in Women with Suspected Preeclampsia. New England Journal of Medicine. 2016 Jan 7;374(1):13–22.
25. Garovic VD. The Role of the Podocyte in Preeclampsia. Clin J Am Soc Nephrol. 2014 Aug 7;9(8):1337–40.
26. Wide-Swensson D, Strevens H, Willner J. Antepartum percutaneous renal biopsy. Int J Gynaecol Obstet. 2007 Aug;98(2):88–92.
27. Shiiki H, Dohi K, Hanatani M, Fujii Y, Sanai H, Ichijo M, et al. Focal and segmental glomerulosclerosis in preeclamptic patients with nephrotic syndrome. Am J Nephrol. 1990;10(3):205–12.
28. Linsell L, Malouf R, Morris J, Kurinczuk JJ, Marlow N. Risk Factor Models for Neurodevelopmental Outcomes in Children Born Very Preterm or With Very Low Birth Weight: A Systematic Review of Methodology and Reporting. Am J Epidemiol. 2017 Apr 1;185(7):601–12.
29. Guellec I, Lapillonne A, Marret S, Picaud J-C, Mitanchez D, Charkaluk M-L, et al. Effect of Intra- and Extrauterine Growth on Long- erm Neurologic Outcomes of Very Preterm Infants. J Pediatr. 2016 Aug;175:93–99.e1.
30. Moore T, Hennessy EM, Myles J, Johnson SJ, Draper ES, Costeloe KL, et al. Neurological and developmental outcome in extremely preterm children born in England in 1995 and 2006: the EPICure studies. BMJ. 2012 Dec 4;345:e7961.
31. Guillén Ú, DeMauro S, Ma L, Zupancic J, Roberts R, Schmidt B, et al. Relationship Between Attrition and Neurodevelopmental Impairment Rates in Extremely Preterm Infants at 18 to 24 Months: A Systematic Review. Arch Pediatr Adolesc Med. 2012 Feb 6;166(2):178–84.
32. Ranke MB, Schweizer R, Rodemann SM, Bevot A, Martin DD, Goelz R, et al. Schoolchildren born VLBW or VLGA show height-related changes in body composition and muscle function but no evidence of metabolic syndrome risk factors. Results from the NEOLONG study. Journal of Pediatric Endocrinology and Metabolism. 2015;29(2):163–172.
33. Castanys?Muñoz E, Kennedy K, Castañeda?Gutiérrez E, Forsyth S, Godfrey KM, Koletzko B, et al. Systematic review indicates postnatal growth in term infants born small?for?gestational?age being associated with later neurocognitive and metabolic outcomes. Acta Paediatr. 2017 Aug;106(8):1230–8.
34. Ong KK, Kennedy K, Castañeda-Gutiérrez E, Forsyth S, Godfrey KM, Koletzko B, et al. Postnatal growth in preterm infants and later health outcomes: a systematic review. Acta Paediatr. 2015 Oct;104(10):974–86.
35. Low Birth Weight and Nephron Number Working Group. The Impact of Kidney Development on the Life Course: A Consensus Document for Action. Nephron. 2017;136(1):3–49.
36. Luyckx VA, Bertram JF, Brenner BM, Fall C, Hoy WE, Ozanne SE, et al. Effect of fetal and child health on kidney development and long-term risk of hypertension and kidney disease. Lancet. 2013 Jul 20;382(9888):273–83.
37. Luyckx VA, Brenner BM. Birth weight, malnutrition and kidney- ssociated outcomes--a global concern. Nat Rev Nephrol. 2015 Mar;11(3):135–49.
38. Davison JM, Lindheimer MD. Pregnancy and chronic kidney disease. Semin Nephrol. 2011 Jan;31(1):86–99.
39. Hall M. Pregnancy in Women With CKD: A Success Story. Am J Kidney Dis. 2016 Oct;68(4):633–9.
40. Nevis IF, Reitsma A, Dominic A, McDonald S, Thabane L, Akl EA, et al. Pregnancy outcomes in women with chronic kidney disease: a systematic review. Clin J Am Soc Nephrol. 2011 Nov;6(11):2587–98.
41. Cabiddu G, Castellino S, Gernone G, Santoro D, Moroni G, Giannattasio M, et al. A best practice position statement on pregnancy in chronic kidney disease: the Italian Study Group on Kidney and Pregnancy. J Nephrol. 2016 Jun;29(3):277–303.
42. Garg AX, Nevis IF, McArthur E, Sontrop JM, Koval JJ, Lam NN, et al. Gestational hypertension and preeclampsia in living kidney donors. N Engl J Med. 2015 Jan 8;372(2):124–33.
43. Josephson MA. Transplantation: pregnancy after kidney donation: more questions than answers. Nat Rev Nephrol. 2009 Sep;5(9):495–7.
44. Gianfreda D, Quaglini S, Frontini G, Raffiotta F, Messa P, Moroni G. Does pregnancy have any impact on long term damage accrual and on the outcome of lupus nephritis? J Autoimmun. 2017 Nov;84:46–54.
45. Blom K, Odutayo A, Bramham K, Hladunewich MA. Pregnancy and Glomerular Disease: A Systematic Review of the Literature with Management Guidelines. Clin J Am Soc Nephrol. 2017 May 18.
46. Imbasciati E, Gregorini G, Cabiddu G, Gammaro L, Ambroso G, Del Giudice A, et al. Pregnancy in CKD stages 3 to 5: fetal and maternal outcomes. Am J Kidney Dis. 2007 Jun;49(6):753–62.
47. Fischer MJ. Chronic kidney disease and pregnancy: maternal and fetal outcomes. Adv Chronic Kidney Dis. 2007 Apr;14(2):132–45.
48. Bramham K. Diabetic Nephropathy and Pregnancy. Semin Nephrol. 2017 Jul;37(4):362–9.
49. Eswarappa M, Rakesh M, Sonika P, Snigdha K, Midhun M, Kaushik K, et al. Spectrum of renal injury in pregnancy-induced hypertension: Experience from a single center in India. Saudi Journal of Kidney Diseases and Transplantation. 2017 Mar 1;28(2):279.
50. Prakash J. The kidney in pregnancy: A journey of three decades. Indian J Nephrol. 2012;22(3):159–67.
51. Piccoli GB, Fassio F, Attini R, Parisi S, Biolcati M, Ferraresi M, et al. Pregnancy in CKD: whom should we follow and why? Nephrol Dial Transplant. 2012 Oct;27 Suppl 3:iii111-118.
52. Piccoli GB, Cabiddu G, Daidone G, Guzzo G, Maxia S, Ciniglio I, et al. The children of dialysis: live-born babies from on-dialysis mothers in Italy--an epidemiological perspective comparing dialysis, kidney transplantation and the overall population. Nephrol Dial Transplant. 2014 Aug;29(8):1578–86.
53. Jesudason S, Grace BS, McDonald SP. Pregnancy Outcomes According to Dialysis Commencing Before or After Conception in Women with ESRD. Clin J Am Soc Nephrol. 2014 Jan 7;9(1):143–9.
54. Hladunewich MA, Hou S, Odutayo A, Cornelis T, Pierratos A, Goldstein M, et al. Intensive hemodialysis associates with improved pregnancy outcomes: a Canadian and United States cohort comparison. J Am Soc Nephrol. 2014 May;25(5):1103–9.
55. Piccoli GB, Minelli F, Versino E, Cabiddu G, Attini R, Vigotti FN, et al. Pregnancy in dialysis patients in the new millennium: a systematic review and meta-regression analysis correlating dialysis schedules and pregnancy outcomes. Nephrol Dial Transplant. 2016Nov;31(11):1915–34.
56. Deshpande NA, James NT, Kucirka LM, Boyarsky BJ, Garonzik- ang JM, Montgomery RA, et al. Pregnancy outcomes in kidney transplant recipients: a systematic review and meta-analysis. Am J Transplant. 2011 Nov;11(11):2388–404.
57. Deshpande NA, Coscia LA, Gomez-Lobo V, Moritz MJ, Armenti VT. Pregnancy after solid organ transplantation: a guide for obstetric management. Rev Obstet Gynecol. 2013;6(3–4):116–25.
58. Bramham K, Nelson-Piercy C, Gao H, Pierce M, Bush N, Spark P, et al. Pregnancy in renal transplant recipients: a UK national cohort study. Clin J Am Soc Nephrol. 2013 Feb;8(2):290–8.
59. Piccoli GB, Cabiddu G, Attini R, Gerbino M, Todeschini P, Perrino ML, et al. Outcomes of Pregnancies After Kidney Transplantation: Lessons Learned from CKD. A Comparison of Transplanted, Nontransplanted Chronic Kidney Disease Patients and Low-Risk Pregnancies: A Multicenter Nationwide Analysis. Transplantation. 2017 Oct;101(10):2536–44.
60. Webster P, Lightstone L, McKay DB, Josephson MA. Pregnancy in chronic kidney disease and kidney transplantation. Kidney Int. 2017 May;91(5):1047–56.
61. Pietrzak B, Mazanowska N, Kociszewska-Najman B, Szymusik I, Grzechoci?ska B, Pazik J, et al. Successful Pregnancy Outcome after In Vitro Fertilization in a Kidney Graft Recipient: A Case Report and Literature Review. Ann Transplant. 2015 Jun 16;20:338–41.
62. Norrman E, Bergh C, Wennerholm U-B. Pregnancy outcome and long-term follow-up after in vitro fertilization in women with renal transplantation. Hum Reprod. 2015 Jan 1;30(1):205–13.
63. Tedeschi SK, Bermas B, Costenbader KH. Sexual disparities in the incidence and course of SLE and RA. Clin Immunol. 2013 Nov;149(2):211–8.
64. Marder W, Vinet É, Somers EC. Rheumatic autoimmune diseases in women and midlife health. Womens Midlife Health [Internet]. 2015 [cited 2017 Oct 19];1. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5444314/
65. Ortona E, Pierdominici M, Maselli A, Veroni C, Aloisi F, Shoenfeld Y. Sex-based differences in autoimmune diseases. Ann Ist Super Sanita. 2016 Jun;52(2):205–12.
66. Petri M. Epidemiology of systemic lupus erythematosus. Best Pract Res Clin Rheumatol. 2002 Dec;16(5):847–58.
67. Weckerle CE, Niewold TB. The unexplained female predominance of systemic lupus erythematosus: clues from genetic and cytokine studies. Clin Rev Allergy Immunol. 2011 Feb;40(1):42–9.
68. Scofield RH, Bruner GR, Namjou B, Kimberly RP, Ramsey-Goldman R, Petri M, et al. Klinefelter’s syndrome (47,XXY) in male systemic lupus erythematosus patients: support for the notion of a gene-dose effect from the X chromosome. Arthritis Rheum. 2008 Aug;58(8):2511–7.
69. Pierdominici M and Ortona E. Estrogen Impact on Autoimmunity Onset and Progression: the Paradigm of Systemic Lupus Erythematosus. Int Trends in Immun (2013); 1 (2):24-34.
70. Maselli A, Conti F, Alessandri C, Colasanti T, Barbati C, Vomero M, et al. Low expression of estrogen receptor ? in T lymphocytes and high serum levels of anti-estrogen receptor ? antibodies impact disease activity in female patients with systemic lupus erythematosus. Biol Sex Differ [Internet]. 2016 Jan 12 [cited 2017 Oct 19];7. Available from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4709986/
71. Kim SJ, Schätzle S, Ahmed SS, Haap W, Jang SH, Gregersen PK, et al. Increased cathepsin S in Prdm1(-/-) dendritic cells alters the TFH cell repertoire and contributes to lupus. Nat Immunol. 2017Sep;18(9):1016–24.
72. Langefeld CD, Ainsworth HC, Cunninghame Graham DS, Kelly JA, Comeau ME, Marion MC, et al. Transancestral mapping and genetic load in systemic lupus erythematosus. Nat Commun. 2017 17;8:16021.
73. Niewold TB, Hua J, Lehman TJA, Harley JB, Crow MK. High serum IFN-alpha activity is a heritable risk factor for systemic lupus erythematosus. Genes Immun. 2007 Sep;8(6):492–502.
74. Tower C, Mathen S, Crocker I, Bruce IN. Regulatory T cells in Systemic Lupus Erythematosus and Pregnancy. Am J Reprod Immunol. 2013 Jun 1;69(6):588–95.
75. Almaani S, Meara A, Rovin BH. Update on Lupus Nephritis. CJASN. 2016 Nov 7;CJN.05780616.
76. Buyon JP, Kim MY, Guerra MM, Lu S, Reeves E, Petri M, et al. Kidney Outcomes and Risk Factors for Nephritis (Flare/De Novo) in a Multiethnic Cohort of Pregnant Patients with Lupus. Clin J Am Soc Nephrol. 2017 Jun 7;12(6):940–6.
77. Yelin E, Yazdany J, Trupin L. Relationship Between Process of Care and a Subsequent Increase in Damage in Systemic Lupus Erythematosus. Arthritis Care & Research. 2017 Jun 1;69(6):927–32.
78. Kaplowitz ET, Ferguson S, Guerra M, Laskin CA, Buyon JP, Petri M, et al. Socioeconomic Status Contributes to Racial/Ethnic Disparities in Adverse Pregnancy Outcomes among Women with Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken). 2017 May 8.
79. Myasoedova E, Crowson CS, Kremers HM, Therneau TM, Gabriel SE. Is the incidence of rheumatoid arthritis rising?: results from Olmsted County, Minnesota, 1955-2007. Arthritis Rheum. 2010 Jun;62(6):1576–82.
80. Goemaere S, Ackerman C, Goethals K, De Keyser F, Van der Straeten C, Verbruggen G, et al. Onset of symptoms of rheumatoid arthritis in relation to age, sex and menopausal transition. J Rheumatol. 1990 Dec;17(12):1620–2.
81. de Man YA, Dolhain RJEM, van de Geijn FE, Willemsen SP, Hazes JMW. Disease activity of rheumatoid arthritis during pregnancy: results from a nationwide prospective study. Arthritis Rheum. 2008 Sep 15;59(9):1241–8.
82. Icardi A, Araghi P, Ciabattoni M, Romano U, Lazzarini P, Bianchi G. [Kidney involvement in rheumatoid arthritis]. Reumatismo. 2003;55(2):76–85.
83. Anders H-J, Vielhauer V. Renal co-morbidity in patients with rheumatic diseases. Arthritis Research & Therapy. 2011 Jun 29;13:222.
84. Chiu H-Y, Huang H-L, Li C-H, Chen H-A, Yeh C-L, Chiu S-H, et al. Increased Risk of Chronic Kidney Disease in Rheumatoid Arthritis Associated with Cardiovascular Complications – A National Population-Based Cohort Study. PLOS ONE. 2015 Sep 25;10(9):e0136508.
85. Vinet É, Bernatsky S, Hudson M, Pineau CA, Baron M. Effect of menopause on the modified Rodnan skin score in systemic sclerosis. Arthritis Research & Therapy. 2014 Jun 23;16:R130.
86. Sammaritano LR. Menopause in patients with autoimmune diseases. Autoimmun Rev. 2012 May;11(6–7):A430-436.
87. Penn H, Denton CP. Diagnosis, management and prevention of scleroderma renal disease. Curr Opin Rheumatol. 2008Nov;20(6):692–6.
88. Anders HJ, Wiebecke B, Haedecke C, Sanden S, Combe C, Schlöndorff D. MPO-ANCA-Positive crescentic glomerulonephritis: a distinct entity of scleroderma renal disease? Am J Kidney Dis. 1999 Apr;33(4):e3.
89. Zakharova EV, Makarova TA, Stolyarevich ES. ANCA-Associated Vasculitis in Patient with CREST-Syndrome - Case Report [Internet]. [cited 2017 Oct 19]. Available from: https://www.peertechz.com Clinical-Nephrology/ACN-2-115.php
90. Eckardt K-U, Coresh J, Devuyst O, Johnson RJ, Köttgen A, Levey AS, et al. Evolving importance of kidney disease: from subspecialty to global health burden. Lancet. 2013 Jul 13;382(9887):158–69.
91. Saran R, Robinson B, Abbott KC, Agodoa LYC, Albertus P, Ayanian J, et al. US Renal Data System 2016 Annual Data Report: Epidemiology of Kidney Disease in the United States. Am J Kidney Dis. 2017;69(3 Suppl 1):A7–8.
92. Liyanage T, Ninomiya T, Jha V, Neal B, Patrice HM, Okpechi I, et al. Worldwide access to treatment for end-stage kidney disease: a systematic review. Lancet. 2015 May 16;385(9981):1975–82.
93. Ojo A. Addressing the global burden of chronic kidney disease through clinical and translational research. Trans Am Clin Climatol Assoc. 2014;125:229-243; discussion 243-246.
94. WHO. Addressing gender within primary health care reforms. In: WHO editor. Gender, women and primary health care renewal: a discussion paper [Internet]. [cited 2017 Oct 19]. Available from: http://apps.who.int/iris/bitstream/10665/4443019789241564038_eng.pdf
95. Eguavoen ANT, Odiagbe SO, Obetoh GI. The Status of Women, Sex Preference, Decision-Making and Fertility Control in Ekpoma Community of Nigeria. J Soc Sci. 2007; 15(1):43-9.
96. Halle MP, Takongue C, Kengne AP, Kaze FF, Ngu KB. Epidemiological profile of patients with end stage renal disease in a referral hospital inCameroon. BMC Nephrol. 2015 Apr 21;16:59.
97. Ajayi S, Raji Y, Bello T, Jinadu L, Salako B. Unaffordability of renal replacement therapy in Nigeria. Hong Kong Journal of Nephrology. 2016 Apr 1;18(Supplement C):15–9.
98. Kausz AT, Obrador GT, Arora P, Ruthazer R, Levey AS, Pereira BJ. Late initiation of dialysis among women and ethnic minorities in the United States. J Am Soc Nephrol. 2000 Dec;11(12):2351–7.
99. Coresh J, Byrd-Holt D, Astor BC, Briggs JP, Eggers PW, Lacher DA, et al. Chronic kidney disease awareness, prevalence, and trends among U.S. adults, 1999 to 2000. J Am Soc Nephrol. 2005 Jan;16(1):180–8.
100. Adams SV, Rivara M, Streja E, Cheung AK, Arah OA, Kalantar- adeh K, et al. Sex Differences in Hospitalizations with Maintenance Hemodialysis. J Am Soc Nephrol. 2017 Sep;28(9):2721–8.
101. Ethier J, Mendelssohn DC, Elder SJ, Hasegawa T, Akizawa T, Akiba T, et al. Vascular access use and outcomes: an international perspective from the Dialysis Outcomes and Practice Patterns Study. Nephrol Dial Transplant. 2008 Oct;23(10):3219–26.
102. Depner TA. Prescribing Hemodialysis: The Role of Gender. Advances in Renal Replacement Therapy. 2003 Jan 1;10(1):71–7.
103. Sehgal AR. Outcomes of renal replacement therapy among blacks and women. American Journal of Kidney Diseases. 2000 Apr 1;35(4):S148–52.
104. Jindal RM, Ryan JJ, Sajjad I, Murthy MH, Baines LS. Kidney transplantation and gender disparity. Am J Nephrol. 2005 Oct;25(5):474–83.
105. Couchoud C, Bayat S, Villar E, Jacquelinet C, Ecochard R, REIN registry. A new approach for measuring gender disparity in access to renal transplantation waiting lists. Transplantation. 2012 Sep 15;94(5):513–9.
106. Liu G, Li X, Liu T, Zhao X, Zhang S, Wang J, et al. Gender disparity of living donor renal transplantation in East China. Clin Transplant. 2013 Feb;27(1):98–103.
107. Naghibi O, Naghibi M, Nazemian F. Gender disparity in kidney transplantation. Saudi J Kidney Dis Transpl. 2008 Jul;19(4):545–50.
108. Bal MM, Saikia B. Gender bias in renal transplantation: are women alone donating kidneys in India? Transplant Proc. 2007 Dec;39(10):2961–3.
109. Hogan J, Couchoud C, Bonthuis M, Groothoff JW, Jager KJ, Schaefer F, et al. Gender Disparities in Access to Pediatric Renal Transplantation in Europe: Data from the ESPN/ERA-EDTA Registry. Am J Transplant. 2016 Jul;16(7):2097–105.
110. Gillespie A, Hammer H, Kolenikov S, Polychronopoulou A, Ouzienko V, Obradovic Z, et al. Sex Differences and Attitudes toward Living Donor Kidney Transplantation among Urban Black Patients on Hemodialysis. Clin J Am Soc Nephrol. 2014 Oct 7;9(10):1764–72.
111. Salter ML, McAdams-Demarco MA, Law A, Kamil RJ, Meoni LA, Jaar BG, et al. Age and sex disparities in discussions about kidney transplantation in adults undergoing dialysis. J Am Geriatr Soc. 2014 May;62(5):843–9.
112. Piccoli GB, Attini R, Cabiddu G, Kooij I, Fassio F, Gerbino M, et al. Maternal-foetal outcomes in pregnant women with glomerulonephritides. Are all glomerulonephritides alike in pregnancy? J Autoimmun. 2017 May;79:91–8.
113. Seeger H, Salfeld P, Eisel R, Wagner CA, Mohebbi N. Complicated pregnancies in inherited distal renal tubular acidosis: importance of acid-base balance. J Nephrol. 2017 Jun;30(3):455–60.
114. Yefet E, Tovbin D, Nachum Z. Pregnancy outcomes in patients with Alport syndrome. Arch Gynecol Obstet. 2016 Apr;293(4):739–47.