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Monica Reynolds, Keisha Gibson, Laura H. Mariani, and Michelle A. Hladunewich

This year’s World Kidney Day falls on International Women’s Day, offering the nephrology community an excellent time to reflect on the theme, “Kidneys & Women’s Health: Include, Value, Empower.”

What progress have we made in addressing women’s kidney health? Why do so many unanswered questions remain? Most important, how do we as nephrologists currently care for women with chronic kidney disease (CKD)? How do we empower them?

For many of us, topics in women’s health are fraught with anxiety owing to a poor knowledge base, uncertainties in the literature, or a lack of clinical experience. Yet our patients rely on

Tracy Hampton

Investigators who are designing clinical trials and preclinical studies have realized that results found in males do not always hold true in females, and that there are clear differences in the sexes that should be considered when preventing and treating a wide variety of health issues. Kidney researchers also note that because female physiology is optimized for successful reproduction—which entails large fluctuations in vascular, hemodynamic, and renal function—it’s likely that female kidneys have important differences from those of males.

With this in mind, a team led by scientists at the Keck School of Medicine of the University of Southern California,

Lisa M. Curtis

Enigmas abound in the clinical care and research related to acute kidney injury (AKI). Unfortunately, little conversion of research findings to changes in patient care has occurred.

The complexities associated with staging clinical AKI and identifying the timing of the insult, as well as the inability to identify characteristics that clearly define why and how certain patients recover while others progressively decline in renal function—some leading to chronic kidney disease (CKD)—all lead to an unsatisfying status of care for patients. Likewise, discordant findings in pre-clinical models of AKI have led to more questions than answers.

Sex remains a variable that

WOMEN AND KIDNEY DISEASES

Chronic kidney disease affects approximately 195,000 women worldwide and causes close to 600,000 deaths per year. A recent review in Seminars in Nephrology looks at patterns of care affecting the burden of CKD among women, noting important effects of sex, referring to biological differences; as well as gender, reflecting social differences.

Some biological differences between the sexes are well known but are typically not considered in CKD care. A prime example is anemia: although women typically have lower hemoglobin and hematocrit levels, current CKD guidelines do not include sex-specific targets for anemia. An issue

Studies have shown gender disparities in care for many chronic diseases, and ESRD is no exception.

Studies from the early 2000s suggested that women had lower rates of hemodialysis initiation using an arteriovenous fistula (AVF), the preferred hemodialysis vascular access. A recent study in Hemodialysis International analyzed gender-related differences in AVF use at dialysis initiation, including variations between ESRD regional networks.

Mariana Markell, MD, and colleagues of SUNY Downstate School of Medicine, Brooklyn, analyzed US Renal Data System data on 202,999 patients initiating hemodialysis between 2006 and 2009. The analysis was limited to 187,577 patients who received predialysis

Leif Oxburgh and Barry Smith

The facts are straightforward. A kidney transplant is the optimal therapy for renal replacement therapy in ESRD. It is optimal from the point of view of its ability to restore both the health and quality of life of the individual affected and its long-term cost-effectiveness. Dialysis, whether hemo- or peritoneal and whether in-center or at home, is life preserving and necessary, but in the final analysis, it cannot compete with transplantation.

Today, 104,706 people are on the waiting list for a kidney transplant. In 2016, only 19,061 kidney transplants were accomplished. Roughly one-third of these involved living organ donors, and

Alejandro Diez

It is well established that kidney transplantation is the treatment of choice for patients with end stage renal disease (ESRD), as this treatment modality has been shown to provide improved patient survival and quality of life compared with dialysis (1). In an ideal system, patients in need of a kidney transplant would receive one as soon as the need arises. Unfortunately, the well-described mismatch between a limited number of available organs and the larger number of patients in need of a transplant makes this impossible, necessitating policies for the allocation of this limited resource. Available organs had been,

Children with focal segmental glomerulosclerosis (FSGS) who undergo kidney transplantation are at high risk of recurrent disease and allograft failure. A new study provides insights into long-term posttransplant survival for this group of patients.

The retrospective study in American Journal of Kidney Diseases included 12,303 pediatric patients receiving a first kidney transplant from 1990 through 2009, identified from the US Renal Data System database. In 11% of patients, FSGS was the primary cause of end stage renal disease. All-cause mortality and allograft loss were compared for patients with FSGS versus other causes.

All-cause mortality for children with FSGS

David White

The numbers speak for themselves. There are currently 121,678 people waiting for life-saving organ transplants in the US. Of these, 100,791 await kidney transplants. A patient is added to the kidney waitlist every 14 minutes and 13 people die every day waiting for a kidney transplant (1). These numbers and their implications led to the Kidney Week 2017 session, Political Correctness? Public Policy Influences on Transplantation, moderated by Roy D. Bloom, MD, and Michelle A. Josephson, MD.

In the segment Kidney Allocation Changes: Past, Present, and Future, Richard N. Formica, MD, of the Yale School of

Bridget M. Kuehn

Older kidney recipients can benefit from organs from older donors. But previous cerebrovascular disease may reduce the survival benefits of these kidney transplants, according to a recent study.

Kidney transplants offer many advantages over dialysis for people with end stage renal disease (ESRD). But a shortage of donors can make it particularly difficult for older patients to secure a donor organ, said Amado Andrés, MD, transplant coordinator at the Hospital Universitario 12 de Octobre in Madrid, Spain. Kidneys from older donors, which may have reduced function owing to age-related conditions, are a poor bet for younger patients. But in older