Women With Chronic Kidney Disease Face Unique Challenges

Women With Chronic Kidney Disease Face Unique Challenges
05/27/2016 10:25 am ET | Updated May 27, 2016

Leslie Spry, M.D., FACP
National Kidney Foundation spokesperson; Medical director, Dialysis Center of Lincoln, Neb.
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Women are more likely than men to get kidney disease. But while already living with this potentially debilitating illness, women face additional physiological challenges related to their sex.

Kidney disease, or CKD, doesn’t display severe symptoms until it’s advanced, and it can be diagnosed at any age. For women, early diagnosis might mean avoiding or delaying other potential health issues including menstrual irregularities, sexual dysfunction, bone disease, depression and pregnancy complications.

It’s important to talk to your doctor about potential CKD symptoms you might be experiencing, especially if you’re at high risk including having diabetes or high blood pressure.

Here are five sets of potential challenges that women with CKD may experience:

Menstrual Irregularities. Women with CKD have been shown to commonly experience menstrual irregularities. This can include excessive bleeding, missed periods, and early onset of menopause. In studies of patients with CKD, women enter menopause from 3 to 5 years earlier than patients without CKD. Treatment can be very challenging. Studies of estrogen replacement therapy have shown an increased risk of heart disease and blood clotting disorders. Kidney transplantation will usually correct these abnormalities.

Sexual Dysfunction. Sexual dysfunction includes loss of libido, fatigue, loss of energy, vaginal dryness and painful intercourse. Many medications used to treat kidney disease, including high blood pressure medications, may cause physical and psychological symptoms that cause a loss of interest sexual activity. Dialysis, a treatment that helps filter your kidneys for you, can correct or improve some of these symptoms. Use of vaginal lubricants and vaginal estrogen have been used for dryness and painful intercourse.

Pregnancy. Women with decreased kidney function are less likely to become pregnant than the general population. Once the kidney function declines to less than 20 percent of normal, it is uncommon for women to become pregnant. Failure to ovulate and miscarriage are very common outcomes in women with CKD and women who are on dialysis. High blood pressure is common in women with CKD and if pregnancy occurs, worsening of high blood pressure is commonly seen. Studies have shown that women who perform dialysis more than 24 hours per week were more likely to have a successful birth. Women with CKD who become pregnant may lose significant amounts of kidney function during pregnancy and need dialysis treatment. Kidney transplantation will improve the likelihood of pregnancy but will not return it to rates in the normal population.

Bone disease. Bone disease including osteoporosis is very common in women with CKD and who are on dialysis. Calcium supplements and Vitamin D are commonly used to treat bone chemical problems in women with CKD. These treatments may help to treat bone disease. Women with CKD may not be able to use traditional osteoporosis medications such as bisphosphonates.

Depression. Depression is common to all with chronic medical illness including CKD. In the general population, women manifest depression at about twice the rate of men. One in four women on dialysis will screen positive for depressive illness. Unfortunately, there are very few studies that have examined screening and treatment of depressive illness in women. My experience would suggest that conventional treatments for depression should be effective in both CKD and dialysis patients.

Both men and women with diabetes and high blood pressure have an increased risk for kidney disease. Request simple urine (ACR) and blood (eGFR) tests if you’re at risk. For more information about CKD, visit the National Kidney Foundation at www.kidney.org.

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