Gender Issues in Chronic Kidney Disease

Gender influences the incidence, prevalence and progression of CKD. In numerous experimental models of renal disease, progression is accelerated in male animals. This disparity in the course of renal disease is replicated by hormonal manipulation, suggesting that the actions of sex hormones, rather than structural differences between the sexes, are responsible for gender dimorphism in renal disease progression. Selective estrogen receptor modulators, which lack the detrimental effects of estrogen on reproductive tissue, have a beneficial effect on the course of CKD in animal models. Sex hormones influence many of the processes known to mediate progressive renal injury including cell proliferation, mesangial matrix synthesis and degradation, generation of reactive oxygen species as well as expression of pro-fibrotic pro-inflammatory cytokines, hormones and vasoactive agents. In humans the progression of non-diabetic and diabetes-related chronic kidney disease is arguably more rapid in men than in women, a finding which parallels observations in experimental animals.