Don’t neglect your kidney health

That World Kidney Day, celebrated on the second Thursday of March every year, coincided last month with International Women’s Day presented an occasion to think about the two subjects together — women and kidney health — and reflect on them. File photo

That World Kidney Day, celebrated on the second Thursday of March every year, coincided last month with International Women’s Day presented an occasion to think about the two subjects together — women and kidney health — and reflect on them.

This is the 13th anniversary of World Kidney Day which promotes affordable healthcare and prevention of diseases for all girls and women. This is also an opportunity to focus on people who are at the risk of developing kidney diseases.

There are few kidney diseases which specifically affect women. They are kidney and urinary tract infections, pregnancy and related kidney diseases which may have a bearing on future kidney functions, failure, autoimmune diseases like systemic lupus erythematosus (SLE), rheumatoid arthritis etc.

There is also a significant disparity between men and women in accessing kidney healthcare all over the world. Women and children representing 50% of any population the world over, the same is not true when it comes to their access to many of the basic requirements of a healthy life.

There is a disparity in their access to education, jobs and healthcare. And their access to kidney health is an exception.

Pregnancy complications

Women are particularly prone to kidney problems during pregnancy and these may continue even after the delivery and long after that as well.

Pregnancy is a situation which happens to be the major cause of acute renal failure or acute kidney injury (AKI) in women. Septic abortions due to illegal procedures are the major cause of acute renal failure (AKI) in countries where legal abortions are not permitted and hypertension during pregnancy (Pre-eclampsia) is the leading cause in developed countries after assisted fertilisation.

In preeclampsia (hypertension during pregnancy), the kidney is the main target leading to hypertension, protein in the urine, acute renal failure (AKI). Acute renal failure and hypertension related to pregnancy may later lead to permanent kidney failure or chronic kidney disease (CKD).

Also, pre-existing chronic kidney disease (CKD) has deleterious effects on pregnancy even in initial stages. Thus, pregnancy increases the risk of further progression of chronic kidney disease. This may be a significant challenge in our country, where there are a lot of social and ethical challenges for any woman of childbearing age, who might have CKD. In case a woman already has CKD, any pressure on her to continue with the pregnancy can increase the chance of her suffering from kidney failure. 

Apart from CKD, the risk for hypertension during pregnancy include manifestation of diabetes, immunologic diseases, underlying systemic hypertension, obesity and metabolic syndrome, which by themselves, are risk factors for CKD.

Even in women with CKD, who may need treatment in the form of dialysis or any form of replacement of kidney functions, only a fraction of women get the needed care. Even in developed countries like Japan only 50% of women with kidney diseases get treated properly.

Dismal gender ratio

In the US also, the ratio of men to women actually receiving dialysis is 1.7:1. Of the many patients who need dialysis because of kidney failure, very few get the proper treatment in our country. And the estimates are that only 2% of end-stage renal failure patients receive kidney replacement therapy (dialysis or transplant) in developing countries.

Kidney transplantation is the best form of treatment in end-stage renal failure patients. Worldwide data indicates that women are less likely to receive kidney transplantation than men. Women are also less likely to be registered in the waiting list for kidney transplantation.

Also, mothers and female spouses are more likely to be the renal donors for their sons or husbands. Sex inequality exists even in paediatric population, girls have less access to kidney transplantation than boys. There is definitely a need for greater awareness, timely diagnosis and accurate follow-up of CKD during pregnancy. Pregnancy also may give us an opportunity to diagnose early kidney problems and help us plan a timely intervention. Emphasising the need for improved access to care of women is the cornerstone to maintain the health of families, populations and growth of any country.

Socioeconomic factors play a major role in this inequality of transplantation, especially in low and middle-income countries.

(The writer is HOD and consultant nephrologist, Manipal Hospitals, Bengaluru)

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