World Kidney Day is a global awareness campaign aimed at raising awareness of the importance of our kidneys. It is celebrated worldwide on annual basis on the 2nd Thursday of March. In 2018, it coincided with International Women’s day. So, commemorating these two days together, the theme of World Kidney day 2018 was kept Kidneys & Women’s Health: Include, Value, Empower to reflect on the importance of women’s health and specifically their kidney health.
Chronic Kidney Disease (CKD)
Chronic kidney disease (CKD) affects approximately 10% of the world’s adult population. It is one of the top 20 causes of death worldwide.
In India, the approximate prevalence of CKD is 800 per million population (pmp), and the incidence of end-stage renal disease (ESRD) is 150–200 pump.
CKD affects approximately 195 million women worldwide and is currently the 8th leading cause of death in women, with close to 600,000 deaths each year.
The risk of developing CKD is high in women as in men.
Chronic kidney disease is often clinically and biochemically silent until renal impairment is advanced and can lead to kidney failure or end-stage renal disease (ESRD) if it is not detected and treated early.
Prominent Effects of Chronic Kidney Diseases in Women Health
Preconception or Fertility
– Women with chronic kidney disease often have irregular periods or amenorrhoea (absence of menstrual cycles) but may still occasionally ovulate and thus conceive.
– Preconception counselling is important
- Regular review of drugs is utmost important. Certain drugs may adversely affect the foetus. E.g Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers.
- Sometimes, CKDs are genetic in origin have a probability to be passed on to the future progeny. The most common inherited renal condition, Autosomal dominant polycystic kidney disease, is passed on to 50% of offspring.
– It is recommended to wait for a period of 6 months after the latest episode of disease flare before attempting to conceive and delaying conception until 12 months post-transplantation.
-Women with Mild renal impairment (stages 1-2) who become pregnant have mild renal dysfunction and pregnancy does not usually affect renal prognosis.
-But pregnant women with moderate to severe renal impairment can have following complications
- Maternal hypertension
- Proteinuria: Excretion of Albumin in urine
- Recurrent urinary tract infection
- Chronic hypertension
- Preeclampsia: a syndrome characterized by the onset of hypertension and proteinuria after 20 weeks of gestation in a previously normotensive woman
- Fetal growth restriction or low birth weight
Menopause and CKD
– Relative to women with normal or near-normal kidney function, women with CKD experienced an earlier menopause.
-Earlier menopause may have potentially adverse effects on bone health, cardiovascular risk and sexual function.
-Women lose an average of 25 per cent of their bone mass from the time of menopause to age 60, due in large part to the loss of female sex hormones: estrogen.
-Kidneys are involved in excretion of phosphorus conversion of Vitamin D into an active form which absorbs Calcium from it. Thus, High phosphorus levels and lack of vitamin D, in CKD causes Calcium deficiency.
– To compensate for the deficiency of calcium in the body there is activation of parathyroid hormone, which increases level of blood calcium by moving it from bone, decreasing bone mineral density, Osteoporosis, a ‘brittle-bone’ disease, occurs when the inside of bones becomes less dense, making them more fragile and likely to fracture.
– Additional calcium in the diet, or in the form of supplements, can help prevent bone loss.
1.Chronic kidney disease in pregnancy. David Williams; John Davison. BMJ. 2008; 336(7637): 211–215.
2. Pregnancy in women with the renal disease. Yes or no? K Edipidis. Hippokratia. 2011 Jan; 15(Suppl 1): 8–12.
3.Menopausal Symptoms in Women with Chronic Kidney Disease. Katharine L. Cheung, Marcia L. Stefanick; Manjula Kurella Tamura.Menopause. 2015 Sep; 22(9): 1006–1011.