Women with Kidney Disease Are Undertreated and Left Behind by Decades of Male-Dominated Research

• Women encounter barriers even when disease is present — Chronic kidney disease remains one of the most underdiagnosed health conditions worldwide, and women face an additional burden. In this featured Series published in The Lancet, researchers reported that up to 30% to 50% of chronic kidney disease cases go undiagnosed in high-income countries.

Women and nonwhite individuals are up to twice as likely to remain undiagnosed as white men, while nine out of 10 people who have chronic kidney disease don’t know they have the condition.

• Testing and referrals happen less often for women — Women are less likely to receive kidney disease testing, specialist referrals, and cardiovascular risk management even when their clinical results are similar to those of men. From a practical standpoint, this means you could have the same laboratory findings as a male patient yet be less likely to receive the same level of attention or follow-up care.

• Research participation does not reflect who actually has the disease — Fewer than 45% of participants in kidney disease trials are women, and representation falls to roughly one-third in some studies involving kidney medications. If treatments are tested primarily in men, doctors have less information about how those therapies affect women in real-world settings.

• Important treatment differences emerge when scientists examine women separately — The paper described several examples where women responded differently than men. In the SONAR trial, the drug atrasentan provided greater kidney protection in women, but women also experienced more heart failure events.

In the REGENCY trial, which involves lupus nephritis, a kidney disease caused by autoimmune dysfunction, women responded substantially better to the drug obinutuzumab, while men achieved better outcomes without treatment. These findings suggest that averaging results across both sexes can hide clinically important differences that directly affect treatment decisions.

• Biology helps explain why one-size-fits-all medicine falls short — Genetics, hormone levels, kidney structure, and drug metabolism differ between women and men. Drug metabolism refers to how your body absorbs, processes, and eliminates medications.

Because those processes differ between sexes, the same medication can produce different benefits, risks, and side effects. The researchers argue that future studies should routinely analyze women and men separately so treatment recommendations better reflect how real patients respond.

• The numbers showed a consistent enrollment gap — Across all 192 trials, women accounted for 66,875 participants, or 45.4% of those enrolled. At first glance, that might sound reasonably balanced. However, the researchers compared trial participation against the real-world burden of disease and found women represented about 55% of the global chronic kidney disease population.

To measure this discrepancy, they calculated something called the participation-to-prevalence ratio. That score compares how many women are enrolled in studies versus how many women actually have the disease. A perfect match would score 1.0. Instead, the average score was 0.75, showing women consistently appeared in trials at lower rates than expected.

• The imbalance remained regardless of study design — Underrepresentation remained similar whether studies focused on earlier or later stages of kidney disease, whether participants received dialysis or not, whether trials were funded by industry or other organizations, and whether the intervention involved drugs, devices, or other approaches.

Europe showed the largest imbalance, with a participation-to-prevalence ratio of just 0.65. Even more concerning, the researchers found no meaningful improvement between 1995 and 2022. Decades passed without solving the problem.

• Researchers rarely analyzed women separately — If you enjoy tracking your own health data, imagine combining your results with someone else’s and not separating them again. That’s essentially what happened in most of these trials. Only 39 of the 192 studies, just 20%, reported effectiveness outcomes separately for women and men.

When researchers fail to separate results by sex, important differences become invisible. The review found only one trial that identified a meaningful difference between women and men after performing sex-specific analysis. That finding alone illustrates how much information remains hidden when investigators don’t look.

• Safety data were almost completely missing — Not a single trial reported adverse events — unwanted reactions or complications that occur during treatment — separately for women and men. This matters because the paper highlighted evidence from broader drug-safety databases showing that women often experience different side effects than men due to differences in how medications move through and interact with the body.

Factors such as hormone levels, body composition, and drug metabolism influence those responses. Without sex-specific safety reporting, doctors and patients are left with an incomplete picture of risk.

• The study identified practical fixes for the future — The researchers outlined several ways to improve research quality. They argued that clinical trials should plan sex-specific analyses before studies begin, include enough women to make those analyses meaningful, and remove enrollment barriers that disproportionately affect women.

The authors also noted that caregiving responsibilities, communication barriers, and study designs that unintentionally favor male participation all contribute to lower enrollment rates. Addressing those obstacles would give women a stronger voice in research and generate treatment data that better reflects the patients who actually live with the disease.

• Disease progression tells only part of the story — According to the analysis, men experienced a faster decline in kidney function in CKD-DOPPS clinics located in Brazil, France, Germany, and the U.S., helping explain why more men reached kidney replacement therapy, meaning dialysis or transplantation. However, the researchers emphasized that biology alone doesn’t explain the entire gap.

They pointed out that many important events occur before a patient ever reaches a specialist kidney clinic, including whether primary care providers recognize the disease and whether patients receive timely referrals. For you as a patient, this highlights the importance of identifying kidney problems early rather than waiting until advanced disease develops.

• Family responsibilities often compete with personal health — Researchers surveyed kidney specialists from 22 countries and found recurring themes that limited women’s access to advanced care. Economic inequality, caregiving duties, and family responsibilities repeatedly surfaced as obstacles. Many women spend years helping spouses, children, parents, and grandchildren while delaying their own medical appointments.

The paper suggests that this pattern contributes to later diagnoses, fewer specialist visits, and reduced access to treatment when compared with men.

• Social support and financial resources influence outcomes — Women were less frequently employed than men, creating additional challenges in health care systems where insurance or health care access is tied to employment status. Men were also more likely to be married, which often translates into greater logistical support during illness.

Transportation, appointment scheduling, treatment adherence, and emotional support all become easier when another person helps coordinate care. These factors aren’t medical measurements, but they still influence who receives treatment and when.

• Pregnancy complications create an overlooked warning sign — Another important finding centered on hypertensive disorders of pregnancy, including preeclampsia and pregnancy-induced high blood pressure. These conditions involve elevated blood pressure during pregnancy and are associated with a greater risk of future kidney disease and cardiovascular disease.

The global number of pregnancies affected by these disorders increased from 16.3 million to 18.08 million between 1990 and 2019. That means a pregnancy complication from years ago isn’t simply a past event. It can serve as an early warning sign that your kidneys deserve closer monitoring later in life.

• Earlier intervention offers one of the biggest opportunities for change — Unlike many discussions that focus only on dialysis or transplantation, this paper emphasized the value of acting long before severe disease develops. Identifying high-risk women earlier, especially those with a history of pregnancy-related complications, creates opportunities to slow disease progression and reduce future complications.

They also suggested that educating primary care providers about kidney disease risk factors could improve recognition and treatment at earlier stages. Viewed through that lens, one of the most powerful tools isn’t a new drug or procedure. It’s recognizing risk sooner and responding before kidney damage advances.

• Restore a healthy sodium-to-potassium balance — If you’re dealing with high blood pressure, focus on mineral balance rather than simply eliminating salt. Blood pressure regulation depends heavily on the balance between sodium and potassium. The larger problem is that most sodium comes from ultraprocessed foods that contain very little potassium.

Replacing those foods with whole foods such as ripe fruit, root vegetables, and well-cooked greens helps restore this balance and reduces stress on your kidneys. At the same time, eliminating ultraprocessed foods lowers exposure to phosphate additives, excess sugar, seed oils, and other compounds that increase your kidneys’ workload.

• Optimize your vitamin D status through sensible sun exposure — Vitamin D helps regulate the hormonal system that controls blood pressure and fluid balance. When vitamin D levels remain low, that system may become overstimulated, which can increase vascular tension and place additional strain on your kidneys. Regular sun exposure is the most effective way to maintain healthy vitamin D levels.

If you still consume seed oils and other major sources of linoleic acid (LA), avoid intense midday sun for at least six months, since LA is a polyunsaturated fat that oxidizes easily, builds up in your skin, and increases your risk of skin damage. Aim for a vitamin D level between 60 and 80 ng/mL (150 to 200 nmol/L) and monitor it throughout the year. If regular sunlight isn’t available, vitamin D3 supplementation helps maintain healthy levels.

• Move every day and lower your stress response — Regular movement improves circulation, supports healthy blood sugar levels, and reduces pressure on your kidney’s filtering units. An hour of walking, cycling, swimming, or similar activity each day supports kidney health without excessive strain. If you’re just getting started, even 10-minute sessions create momentum.

I also recommend addressing the emotional side of high blood pressure. Chronic stress triggers hormones that constrict blood vessels and drive blood pressure upward.

One simple strategy is box breathing: inhale for four seconds, hold for four seconds, exhale for four seconds, and hold again for four seconds. Practice for 10 minutes daily to help calm your nervous system and reduce unnecessary pressure on your blood vessels.

• Reduce kidney stress from stones and excess phosphorus — If you have a history of kidney stones, pay attention to your oxalate intake. Foods particularly high in oxalates include spinach, almonds, peanut butter, sweet potatoes, and figs. Pairing oxalate-containing foods with calcium-rich foods helps bind oxalates in your digestive tract so fewer reach your kidneys. Low-oxalate greens such as kale work well for this purpose.

Boiling high-oxalate foods and discarding the cooking water further lowers the oxalate load. At the same time, reduce phosphorus from processed foods, colas, and fast-food meats. Excess phosphorus disrupts mineral balance and places additional strain on kidney tissue.

• Stay hydrated and screen early if risk factors apply to you — Hydration helps your kidneys dilute waste products and reduces the risk of stone formation. Thirst is usually a reliable guide, while pale yellow urine generally reflects adequate hydration. If you have high blood pressure, diabetes, obesity, a history of pregnancy-related blood pressure disorders, or a family history of kidney disease, make kidney screening part of your routine health maintenance.

Here, self-advocacy matters more than you might expect. Because women are tested and referred less often than men even when their lab values match a man’s, the most reliable protection is to ask by name. At your next checkup, request two specific tests: eGFR (estimated glomerular filtration rate, a blood test of how well your kidneys filter) and urine albumin (which checks for protein leaking into your urine).

Ask what the numbers are rather than waiting to be told something is wrong. These simple tests detect damage long before symptoms appear, and finding problems early gives you a far greater opportunity to slow progression before permanent damage occurs. The system may not flag you, so flag yourself. Lastly, talk to your health care provider about whether this testing is appropriate for you.