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Vinson AJ, Zhang X, Dahhou M, Süsal C, Döhler B, Melk A, Sapir-Pichhadze R, Cardinal H, Wong G, Francis A, Pilmore H, Grinspan LT, Foster BJ. Differences in excess mortality by recipient sex after heart transplant: An individual patient data meta-analysis. J Heart Lung Transplant 2024; 43:1162-1173. [PMID: 38522764 DOI: 10.1016/j.healun.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 03/07/2024] [Accepted: 03/20/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Identification of differences in mortality risk between female and male heart transplant recipients may prompt sex-specific management strategies. Because worldwide, males of all ages have higher absolute mortality rates than females, we aimed to compare the excess risk of mortality (risk above the general population) in female vs male heart transplant recipients. METHODS We used relative survival models conducted separately in SRTR and CTS cohorts from 1988-2019, and subsequently combined using 2-stage individual patient data meta-analysis, to compare the excess risk of mortality in female vs male first heart transplant recipients, accounting for the modifying effects of donor sex and recipient current age. RESULTS We analyzed 108,918 patients. When the donor was male, female recipients 0-12 years (Relative excess risk (RER) 1.13, 95% CI 1.00-1.26), 13-44 years (RER 1.17, 95% CI 1.10-1.25), and ≥45 years (RER 1.14, 95% CI 1.02-1.27) showed higher excess mortality risks than male recipients of the same age. When the donor was female, only female recipients 13-44 years showed higher excess risks of mortality than males (RER 1.09, 95% CI 1.00-1.20), though not significantly (p = 0.05). CONCLUSIONS In the setting of a male donor, female recipients of all ages had significantly higher excess mortality than males. When the donor was female, female recipients of reproductive age had higher excess risks of mortality than male recipients of the same age, though this was not statistically significant. Further investigation is required to determine the reasons underlying these differences.
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Affiliation(s)
- Amanda J Vinson
- Department of Medicine, Nephrology Division, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Xun Zhang
- Research Institute of the McGill University Health Centre, Montréal, Quebec, Canada
| | - Mourad Dahhou
- Research Institute of the McGill University Health Centre, Montréal, Quebec, Canada
| | - Caner Süsal
- Institute of Immunology, Heidelberg University Hospital, Heidelberg, Germany; Transplant Immunology Research Center of Excellence, Koç University, Istanbul, Turkey
| | - Bernd Döhler
- Institute of Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Anette Melk
- Children's Hospital, Hannover Medical School, Hannover, Germany
| | - Ruth Sapir-Pichhadze
- Department of Medicine, Division of Nephrology, McGill University, Montreal, Quebec, Canada
| | - Heloise Cardinal
- Department of Medicine, Division of Nephrology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Germaine Wong
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Anna Francis
- School of Clinical Medicine, University of Queensland, Brisbane, Australia; Department of Nephrology, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Helen Pilmore
- Department of Renal Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Lauren T Grinspan
- Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Bethany J Foster
- Research Institute of the McGill University Health Centre, Montréal, Quebec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada; Department of Pediatrics, Division of Nephrology, McGill University Faculty of Medicine, Montreal, Quebec, Canada
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Hendren E, Kaur R, Gill J. Are There Sex-based Differences in Excess Risk of Death With Graft Function After Kidney Transplant? Transplantation 2024; 108:1279-1280. [PMID: 38755749 DOI: 10.1097/tp.0000000000005055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Affiliation(s)
- Elizabeth Hendren
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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Vinson AJ, Zhang X, Dahhou M, Süsal C, Döhler B, Sapir-Pichhadze R, Cardinal H, Melk A, Wong G, Francis A, Pilmore H, Foster BJ. A Multinational Cohort Study Examining Sex Differences in Excess Risk of Death With Graft Function After Kidney Transplant. Transplantation 2024; 108:1448-1459. [PMID: 38277260 DOI: 10.1097/tp.0000000000004915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
BACKGROUND Kidney transplant recipients show sex differences in excess overall mortality risk that vary by donor sex and recipient age. However, whether the excess risk of death with graft function (DWGF) differs by recipient sex is unknown. METHODS In this study, we combined data from 3 of the largest transplant registries worldwide (Scientific Registry of Transplant Recipient, Australia and New Zealand Dialysis and Transplant Registry, and Collaborative Transplant Study) using individual patient data meta-analysis to compare the excess risk of DWGF between male and female recipients of a first deceased donor kidney transplant (1988-2019), conditional on donor sex and recipient age. RESULTS Among 463 895 individuals examined, when the donor was male, female recipients aged 0 to 12 y experienced a higher excess risk of DWGF than male recipients (relative excess risk 1.68; 95% confidence interval, 1.24-2.29); there were no significant differences in other age intervals or at any age when the donor was female. There was no statistically significant between-cohort heterogeneity. CONCLUSIONS Given the lack of sex differences in the excess risk of DWGF (other than in prepubertal recipients of a male donor kidney) and the known greater excess overall mortality risk for female recipients compared with male recipients in the setting of a male donor, future study is required to characterize potential sex-specific causes of death after graft loss.
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Affiliation(s)
- Amanda Jean Vinson
- Nephrology Division, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Xun Zhang
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Mourad Dahhou
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Caner Süsal
- Institute of Immunology, Heidelberg University Hospital, Heidelberg, Germany
- Transplant Immunology Research Center of Excellence, Koç University, Istanbul, Turkey
| | - Bernd Döhler
- Institute of Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Ruth Sapir-Pichhadze
- Department of Medicine, Division of Experimental Medicine, McGill University, QC, Canada
| | - Heloise Cardinal
- Division of Nephrology, Department of Medicine, Centre Hospitalier de l'Université de Montreal, Montreal, QC, Canada
| | - Anette Melk
- Children's Hospital, Hannover Medical School, Hannover, Germany
| | - Germaine Wong
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Anna Francis
- School of Clinical Medicine, University of Queensland, QLD, Australia
- Department of Medicine, Division of Nephrology, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Helen Pilmore
- Department of Renal Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Bethany J Foster
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
- Division of Nephrology, Department of Pediatrics, McGill University Faculty of Medicine, QC, Canada
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Magyar CTJ, Gretener CP, Baldi P, Storni F, Kim-Fuchs C, Candinas D, Berzigotti A, Knecht M, Beldi G, Hirzel C, Sidler D, Reineke D, Banz V. Recipient donor sex combinations in solid organ transplantation and impact on clinical outcome: A scoping review. Clin Transplant 2024; 38:e15312. [PMID: 38678586 DOI: 10.1111/ctr.15312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/22/2024] [Accepted: 03/25/2024] [Indexed: 05/01/2024]
Abstract
INTRODUCTION Solid organ transplantation (SOT) is a lifesaving treatment for end-stage organ failure. Although many factors affect the success of organ transplantation, recipient and donor sex are important biological factors influencing transplant outcome. However, the impact of the four possible recipient and donor sex combinations (RDSC) on transplant outcome remains largely unclear. METHODS A scoping review was carried out focusing on studies examining the association between RDSC and outcomes (mortality, graft rejection, and infection) after heart, lung, liver, and kidney transplantation. All studies up to February 2023 were included. RESULTS Multiple studies published between 1998 and 2022 show that RDSC is an important factor affecting the outcome after organ transplantation. Male recipients of SOT have a higher risk of mortality and graft failure than female recipients. Differences regarding the causes of death are observed. Female recipients on the other hand are more susceptible to infections after SOT. CONCLUSION Differences in underlying illnesses as well as age, immunosuppressive therapy and underlying biological mechanisms among male and female SOT recipients affect the post-transplant outcome. However, the precise mechanisms influencing the interaction between RDSC and post-transplant outcome remain largely unclear. A better understanding of how to identify and modulate these factors may improve outcome, which is particularly important in light of the worldwide organ shortage. An analysis for differences of etiology and causes of graft loss or mortality, respectively, is warranted across the RDSC groups. PRACTITIONER POINTS Recipient and donor sex combinations affect outcome after solid organ transplantation. While female recipients are more susceptible to infections after solid organ transplantation, they have higher overall survival following SOT, with causes of death differing from male recipients. Sex-differences should be taken into account in the post-transplant management.
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Affiliation(s)
- Christian Tibor Josef Magyar
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Charlene Pierrine Gretener
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Patricia Baldi
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Federico Storni
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Corina Kim-Fuchs
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel Candinas
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Annalisa Berzigotti
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matthias Knecht
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Guido Beldi
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Cédric Hirzel
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel Sidler
- Department for Nephrology and Hypertension, University Hospital Insel Bern, Bern, Switzerland
| | - David Reineke
- Department of Cardiac Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Vanessa Banz
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Nautiyal A, Bagchi S, Bansal SB. Gender and kidney transplantation. FRONTIERS IN NEPHROLOGY 2024; 4:1360856. [PMID: 38711923 PMCID: PMC11070561 DOI: 10.3389/fneph.2024.1360856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 04/09/2024] [Indexed: 05/08/2024]
Abstract
Kidney transplantation provides the best form of kidney replacement therapy with improvement in quality of life and longevity. However, disparity exists in its availability, utilisation and outcomes, not only due to donor availability or financial constraints but also arising from the influence of biological sex and its sociocultural attribute i.e., Gender. Women make up the majority of kidney donors but are less likely to be counselled regarding transpantation, be waitlisted or receive living/deceased donor kidney. Biological differences also contribute to differences in kidney transplantation among the sexes. Women are more likely to be sensitised owing to pregnancy, especially in multiparous individuals, complicating donor compatibility. A heightened immune system in women, evidenced by more autoimmune illnesses, increases the risk of allograft rejection and loss. Differences in the pharmacokinetics of transplant drugs owing to biological variances could also contribute to variability in outcomes. Transgender medicine is also increasingly becoming a relevant topic of study, providing greater challenges in the form of hormonal manipulations and anatomic changes. It is thus important to determine and study transplantation and its nuances in this backdrop to be able to provide relevant sex and gender-specific interventions and design better practices for optimum kidney transplant utilisation and outcomes.
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Affiliation(s)
- Arushi Nautiyal
- Department of Nephrology, Jaipur Golden Hospital, New Delhi, India
| | - Soumita Bagchi
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
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Melk A, Sugianto RI, Zhang X, Dahhou M, Döhler B, Süsal C, Sapir-Pichhadze R, Wong G, Foster BJ. Influence of donor sex and age on graft outcome in kidney transplantation. Nephrol Dial Transplant 2024; 39:607-617. [PMID: 37596063 DOI: 10.1093/ndt/gfad181] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND There is a known recipient sex-dependent association between donor sex and kidney transplant survival. We hypothesized that donor age also modifies the association between donor sex and graft survival. METHODS First, deceased donor kidney transplant recipients (1988-2019, n = 461 364) recorded in the Scientific Registry of Transplant Recipients, the Australia and New Zealand Dialysis and Transplant Registry and the Collaborative Transplant Study were analyzed. We used multivariable Cox regression models to estimate the association between donor sex and death censored graft loss, accounting for the modifying effects of recipient sex and donor age; donor age was categorized as 5-19, 20-34, 35-49, 50-59 and ≥60 years. Results from cohort-specific Cox models were combined using individual patient data meta-analysis. RESULTS Among female recipients of donors aged <60 years, graft loss hazards did not differ by donor sex; recipients of female donors ≥60 years showed significantly lower graft loss hazards than recipients of male donors of the same age [combined adjusted hazard ratio (aHR) 0.90, 95% CI 0.86-0.94]. Among male recipients, female donors aged <50 years were associated with significantly higher graft loss hazards than same-aged male donors (5-19 years: aHR 1.11, 95% CI 1.02-1.21; 20-34 years: aHR 1.08, 95% CI 1.02-1.15; 35-49 years: aHR 1.07, 95% CI 1.04-1.10). There were no significant differences in graft loss by donor sex among male recipients of donors aged ≥50 years. CONCLUSION Donor age modifies the association between donor sex and graft survival. Older female donors were associated with similar or lower hazards of graft failure than older male donors in both male and female recipients, suggesting a better functional reserve of older female donor kidneys.
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Affiliation(s)
- Anette Melk
- Children's Hospital, Hannover Medical School, Hannover, Germany
| | | | - Xun Zhang
- Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation, Montréal, QC, Canada
| | - Mourad Dahhou
- Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation, Montréal, QC, Canada
| | - Bernd Döhler
- Institute of Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Caner Süsal
- Transplant Immunology Research Center of Excellence, Koç University, Istanbul, Turkey
| | - Ruth Sapir-Pichhadze
- Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation, Montréal, QC, Canada
- Department of Medicine, Division of Nephrology, McGill University, Montréal, QC, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, QC, Canada
| | - Germaine Wong
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Bethany J Foster
- Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation, Montréal, QC, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, QC, Canada
- Department of Pediatrics, Division of Nephrology, McGill University, Montréal, QC, Canada
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7
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Balafa O, Fernandez-Fernandez B, Ortiz A, Dounousi E, Ekart R, Ferro CJ, Mark PB, Valdivielso JM, Del Vecchio L, Mallamaci F. Sex disparities in mortality and cardiovascular outcomes in chronic kidney disease. Clin Kidney J 2024; 17:sfae044. [PMID: 38638550 PMCID: PMC11024840 DOI: 10.1093/ckj/sfae044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Indexed: 04/20/2024] Open
Abstract
Sex (biologically determined) and gender (socially constructed) modulate manifestations and prognosis of a vast number of diseases, including cardiovascular disease (CVD) and chronic kidney disease (CKD). CVD remains the leading cause of death in CKD patients. Population-based studies indicate that women present a higher prevalence of CKD and experience less CVD than men in all CKD stages, although this is not as clear in patients on dialysis or transplantation. When compared to the general population of the same sex, CKD has a more negative impact on women on kidney replacement therapy. European women on dialysis or recipients of kidney transplants have life expectancy up to 44.8 and 19.8 years lower, respectively, than their counterparts of similar age in the general population. For men, these figures stand at 37.1 and 16.5 years, representing a 21% to 20% difference, respectively. Hormonal, genetic, societal, and cultural influences may contribute to these sex-based disparities. To gain a more comprehensive understanding of these differences and their implications for patient care, well-designed clinical trials that involve a larger representation of women and focus on sex-related variables are urgently needed. This narrative review emphasizes the importance of acknowledging the epidemiology and prognosis of sex disparities in CVD among CKD patients. Such insights can guide research into the underlying pathophysiological mechanisms, leading to optimized treatment strategies and ultimately, improved clinical outcomes.
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Affiliation(s)
- Olga Balafa
- Department of Nephrology, University Hospital of Ioannina, Ioannina, Greece
| | | | - Alberto Ortiz
- Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
| | - Evangelia Dounousi
- Nephrology Dept, Faculty of Medicine, University of Ioannina and University Hospital of Ioannina. Ioannina, Greece
| | - Robert Ekart
- Department of Dialysis, Clinic for Internal Medicine, Faculty of Medicine, University Medical Centre Maribor, Maribor, Slovenia
| | - Charles J Ferro
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Patrick B Mark
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Jose M Valdivielso
- Vascular and Renal Traslational Research Group, UDETMA, Biomedical Research Institute of Lleida, IRBLleida, Lleida, Spain
| | - Lucia Del Vecchio
- Department of Nephrology and Dialysis, Sant'Anna Hospital, ASST Lariana, Como, Italy
| | - Francesca Mallamaci
- Department of Nephrology, Dialysis, and Transplantation Azienda Ospedaliera ‘Bianchi-Melacrino-Morelli’ & CNR-IFC, Reggio Calabria, Italy
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8
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Kute V, Chauhan S, Meshram HS. Act Together and Act Now to Overcome Gender Disparity in Organ Transplantation. EXP CLIN TRANSPLANT 2024; 22:17-27. [PMID: 38385369 DOI: 10.6002/ect.mesot2023.l10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Gender disparity refers to the unequal treatment or a perception of individuals based on their gender and arises from differences in socially constructed gender roles. In the field of transplantation, gender inequality arises at different stages, affecting access to medical care, donation practices, and posttransplant followup care. Gender disparity in transplantation is not limited to any geographic region but is thought to be more prevalent in developing nations. An unusually high number of female donations with relatively fewer female recipients is not only attributable to the low economy but a congregation of medical, social, cultural, and psychological factors. Gender disparities can also be shown in transplant-related professional societies. This review highlights the complexities of spousal donation and vulnerability of women, especially in the developing world. There is a growing need to further modify transplant policies to tackle gender disparities, especially in living related donation. Systematic research in the context of gender-related concerns in transplantation will further aid in understanding the complexities and formulating policies for eliminating gender disparities. Gender disparity is a global problem and not merely limited to transplantation.
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Affiliation(s)
- Vivek Kute
- From the Department of Nephrology, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences, Ahmedabad, India
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9
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Chesnaye NC, Carrero JJ, Hecking M, Jager KJ. Differences in the epidemiology, management and outcomes of kidney disease in men and women. Nat Rev Nephrol 2024; 20:7-20. [PMID: 37985869 DOI: 10.1038/s41581-023-00784-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 11/22/2023]
Abstract
Improved understanding of differences in kidney disease epidemiology, management and outcomes in men and women could help nephrologists to better meet the needs of their patients from a sex- and gender-specific perspective. Evidence of sex differences in the risk and outcomes of acute kidney injury is mixed and dependent on aetiology. Women have a higher prevalence of chronic kidney disease (CKD) stages 3-5 than men, whereas men have a higher prevalence of albuminuria and hence CKD stages 1-2. Men show a faster decline in kidney function, progress more frequently to kidney failure and have higher mortality and risk of cardiovascular disease than women. However, the protective effect of female sex is reduced with CKD progression. Women are less likely than men to be aware of, screened for and diagnosed with CKD, started on antiproteinuric medication and referred to nephrologist care. They also consistently report a poorer health-related quality of life and a higher symptom burden than men. Women experience greater barriers than men to access the waiting list for kidney transplantation, particularly with respect to older age and obesity. However, women also have longer survival than men after transplantation, which may partly explain the comparable prevalence of transplantation between the sexes.
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Affiliation(s)
- Nicholas C Chesnaye
- ERA Registry, Amsterdam UMC location University of Amsterdam, Medical Informatics, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Juan Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Division of Nephrology, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Manfred Hecking
- Department of Internal Medicine III, Clinical Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Kitty J Jager
- ERA Registry, Amsterdam UMC location University of Amsterdam, Medical Informatics, Amsterdam, Netherlands.
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands.
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10
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Jankowska M, Soler MJ, Stevens KI, Torra R. Why do we keep ignoring sex in kidney disease? Clin Kidney J 2023; 16:2327-2335. [PMID: 38046033 PMCID: PMC10689162 DOI: 10.1093/ckj/sfad183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Indexed: 12/05/2023] Open
Abstract
Throughout the history of nephrology, little attention has been paid to the sex and gender differences in kidney disease. This lack of awareness prevents optimal diagnosis and management of kidney disease. In today's world of precision medicine, it is imperative to appreciate the differential factors regarding gender and kidney disease. This editorial summarizes the up-to-date literature regarding sex and gender differences in kidney disease and considers areas where knowledge is incomplete and where further research is needed. We address sex-specific effects on chronic kidney disease epidemiology; risks of dialysis underdosing and medication overdosing in women; unexplained loss of female sex advantage in life expectancy during dialysis, and impact of sex on diagnosis and management of genetic kidney disease. We also aim to highlight the impact of gender on kidney health and raise awareness of disparities that may be faced by women, and transgender and gender-diverse persons when a male-model approach is used by healthcare systems. By understanding the link between sex and kidney disease, kidney specialists can improve the care and outcomes of their patients. In addition, research on this topic can inform the development of targeted prevention and intervention strategies that address the specific needs and risk factors of different populations.
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Affiliation(s)
- Magdalena Jankowska
- Department of Nephrology, Transplantology and Internal Medicine, Faculty of Medicine, Medical University of Gdansk, Gdańsk, Poland
| | - María José Soler
- Department of Nephrology, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Nephrology and Transplantation Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Kate I Stevens
- The Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Roser Torra
- Inherited Kidney Diseases, Nephrology Department, Fundació Puigvert, Institut d'Investigacions Biomèdiques Sant Pau (IIB-Sant Pau), Universitat Autónoma de Barcelona, Barcelona, Spain
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11
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von Samson-Himmelstjerna FA, Kolbrink B, Schulte K. Relative excess mortality risk after kidney transplantation: Eve's loss or Adam's win? Kidney Int 2023; 104:619-620. [PMID: 37599023 DOI: 10.1016/j.kint.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 06/20/2023] [Indexed: 08/22/2023]
Affiliation(s)
| | - Benedikt Kolbrink
- Department of Nephrology and Hypertension, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Kevin Schulte
- Department of Nephrology and Hypertension, University Hospital Schleswig-Holstein, Kiel, Germany
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12
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Vinson AJ, Foster BJ. The authors reply. Kidney Int 2023; 104:620-621. [PMID: 37599025 DOI: 10.1016/j.kint.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 06/20/2023] [Indexed: 08/22/2023]
Affiliation(s)
- Amanda J Vinson
- Department of Medicine, Division of Nephrology, Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health, Halifax, Nova Scotia, Canada.
| | - Bethany J Foster
- Research Institute of the McGill University Health Centre, Montréal, Québec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Québec, Canada; Department of Pediatrics, Division of Nephrology, McGill University Faculty of Medicine, Montréal, Québec, Canada
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13
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Truchot A, Raynaud M, Loupy A. Excess mortality after kidney transplantation: does sex matter? Kidney Int 2023; 103:1023-1024. [PMID: 37210193 DOI: 10.1016/j.kint.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/13/2023] [Accepted: 03/17/2023] [Indexed: 05/22/2023]
Abstract
Understanding sex differences in graft outcomes within the course of kidney transplantation is needed to unravel factors leading to the observed disparities and further improve patient management. In this issue, Vinson et al. presented a relative survival analysis comparing the excess risk of mortality in female and male recipients after kidney transplantation. This commentary discusses the major findings but also the challenges of the use of registry data to conduct large-scale analyses.
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Affiliation(s)
- Agathe Truchot
- Paris Institute for Transplantation and Organ Regeneration, Université Paris Cité, Institut National de la Santé et de la Recherche Médicale, U-970, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marc Raynaud
- Paris Institute for Transplantation and Organ Regeneration, Université Paris Cité, Institut National de la Santé et de la Recherche Médicale, U-970, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Alexandre Loupy
- Paris Institute for Transplantation and Organ Regeneration, Université Paris Cité, Institut National de la Santé et de la Recherche Médicale, U-970, Assistance Publique-Hôpitaux de Paris, Paris, France.
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