Department of Medicine, Division of Nephrology, SUNY Downstate Medical Center, Brooklyn, New York, USA.
Curr Opin Nephrol Hypertens. 2019 Mar;28(2):178-182. doi: 10.1097/MNH.0000000000000482.
Despite evidence of gender-specific differences in epidemiology and outcomes in all stages of chronic kidney disease (CKD), most studies ignore the issue of gender. This review addresses this knowledge gap by evaluating data on gender disparity in this population.
Population-based studies indicate a higher prevalence of CKD in women; however, there are fewer women on renal replacement therapy than men. Men may progress to end-stage kidney disease more rapidly. Gender differences in rates of CKD progression may be influenced by potential antifibrotic and antiapoptotic effects of estrogen or proinflammatory deleterious effects of testosterone. Women are referred later for kidney replacement therapy and receive fewer arteriovenous fistulas than men receive, irrespective of race. Women are also less likely to receive kidney transplants as compared with men but are more likely to donate a kidney.
Recommendations for medical management of CKD patients are currently made in a gender-blind manner, despite the fact that women have differing underlying physiology. Addressing gender differences and disparities is an important and overlooked area in the care of patients with kidney disease.
尽管在慢性肾脏病(CKD)的所有阶段都有证据表明流行病学和结局存在性别特异性差异,但大多数研究都忽略了性别的问题。本综述通过评估该人群中性别差异的数据来填补这一知识空白。
基于人群的研究表明,女性 CKD 的患病率更高;然而,接受肾脏替代治疗的女性却比男性少。男性可能会更快地进展为终末期肾病。CKD 进展率的性别差异可能受到雌激素的潜在抗纤维化和抗细胞凋亡作用或睾丸酮的促炎有害作用的影响。女性接受肾脏替代治疗的时间较晚,而且不论种族如何,女性获得动静脉瘘的数量都比男性少。与男性相比,女性接受肾移植的可能性也较小,但女性更有可能捐献肾脏。
尽管女性的基础生理学存在差异,但目前对 CKD 患者的医学管理建议是不分性别的。解决性别差异和差距是肾脏病患者护理中一个重要但被忽视的领域。