Sex and gender disparities in lupus nephropathy and kidney transplantation
DOI:
https://doi.org/10.33393/gcnd.2023.2661Keywords:
Gender, Disparities, Lupus nephritis, Kidney transplantationAbstract
Systemic lupus erythematosus (SLE) has a clear prevalence in females. Although there are conflicting data, among males affected by SLE to a higher proportion develop lupus nephritis, with a more severe histological and clinical pattern than in females. More frequently males also present an antiphospholipid syndrome. Males are less likely to achieve clinical remission of lupus nephritis.
A sex and gender disparity is also present in all the phases preceding the kidney transplant starting from the referral for eligibility and registration on the active waiting list. There is a perception among healthcare staff that women have a greater degree of fragility and are therefore less eligible for kidney transplantation. Women also encounter obstacles in completing the tests necessary for inclusion on the waiting list and in many Health Care contexts they are less likely to have a transplant. In the field of living transplantation, women represent over half of all donors, while males are predominantly recipients. Long-term patient and graft survival appear superior in women compared to men.
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Mandreoli M. Gender and sex in the development and progression of renal diseases. G Clin Nefrol Dial. 2023; 35:51-57. https://doi.org/10.33393/gcnd.2023.2627 DOI: https://doi.org/10.33393/gcnd.2023.2627
Piccoli GB, Alrukhaimi M, Liu ZH, Zakharova E, Levin A; World Kidney Day Steering Committee. What We Do and Do Not Know about Women and Kidney Diseases; Questions Unanswered and Answers Unquestioned: Reflection on World Kidney Day and International Women’s Day. Nephron. 2018;138(4):249-260. https://doi.org/10.1159/000485267 PMID:29439263 DOI: https://doi.org/10.1159/000485267
Ramírez Sepúlveda JI, Bolin K, Mofors J et al. Sex differences in clinical presentation of systemic lupus erythematosus. Biol Sex Diff 2019 16;10(1):60. https://doi.org/10.1186/s13293-019-0274-2 DOI: https://doi.org/10.1186/s13293-019-0274-2
Kim J-W, Kim H-A, Suh C-H, Jung J-Y. Sex hormones affect the pathogenesis and clinical characteristics of systemic lupus erythematosus. Front Med (Lausanne). 2022;9:906475. https://doi.org/10.3389/fmed.2022.906475 PMID:36035435 DOI: https://doi.org/10.3389/fmed.2022.906475
Klein SL, Flanagan KL. Sex differences in immune responses. Nat Rev Immunol. 2016;16(10):626-638. https://doi.org/10.1038/nri.2016.90 PMID:27546235 DOI: https://doi.org/10.1038/nri.2016.90
Sciarra F, Campolo F, Franceschini E, Carlomagno F, Venneri MA. Gender-Specific Impact of Sex Hormones on the Immune System. Int J Mol Sci. 2023;24(7):6302. https://doi.org/10.3390/ijms24076302 PMID:37047274 DOI: https://doi.org/10.3390/ijms24076302
Moulton VR. Sex Hormones in acquired immunity and autoimmune disease. Front Immunol. 2018;9:2279. https://doi.org/10.3389/fimmu.2018.02279 PMID:30337927 DOI: https://doi.org/10.3389/fimmu.2018.02279
Billi AC, Kahlenberg JM, Gudjonsson JE. Sex bias in autoimmunity. Curr Opin Rheumatol. 2019;31(1):53-61. https://doi.org/10.1097/BOR.0000000000000564 PMID:30394940 DOI: https://doi.org/10.1097/BOR.0000000000000564
Bose M, Jefferies C. Sex bias in systemic lupus erythematosus: a molecular insight. Immunometabolism (Cobham). 2022;4(3):e00004. https://doi.org/10.1097/IN9.0000000000000004 PMID:35966636 DOI: https://doi.org/10.1097/IN9.0000000000000004
Riveros Frutos A, Casas I, Rúa-Figueroa I, et al; RELESSER Group, part of the Spanish Society of Rheumatology Systemic Autoimmune Diseases Study Group (EASSER). Systemic lupus erythematosus in Spanish males: a study of the Spanish Rheumatology Society Lupus Registry (RELESSER) cohort. Lupus. 2017;26(7):698-706. https://doi.org/10.1177/0961203316673728 PMID:27799439 DOI: https://doi.org/10.1177/0961203316673728
Trentin F, Signorini V, Manca ML, et al. Gender differences in SLE: report from a cohort of 417 Caucasian patients. Lupus Sci Med. 2023;10(1):e000880. https://doi.org/10.1136/lupus-2022-000880 PMID:37185240 DOI: https://doi.org/10.1136/lupus-2022-000880
Murphy G, Isenberg D. Effect of gender on clinical presentation in systemic lupus erythematosus. Rheumatology (Oxford). 2013;52(12):2108-2115. https://doi.org/10.1093/rheumatology/ket160 PMID:23641038 DOI: https://doi.org/10.1093/rheumatology/ket160
Jarukitsopa S, Hoganson DD, Crowson CS, et al. Epidemiology of systemic lupus erythematosus and cutaneous lupus erythematosus in a predominantly white population in the United States. Arthritis Care Res (Hoboken). 2015;67(6):817-828. https://doi.org/10.1002/acr.22502 PMID:25369985 DOI: https://doi.org/10.1002/acr.22502
Salas MAP, Chua E, Rossi A, et al. Sex and gender disparity in kidney transplantation: historical and future perspectives. Clin Transplant. 2022;36(12):e14814. https://doi.org/10.1111/ctr.14814 PMID:36097741 DOI: https://doi.org/10.1111/ctr.14814
Hogan J, Couchoud C, Bonthuis M, et al; ESPN/ERA-EDTA Registry. Gender disparities in access to pediatric renal transplantation in Europe: data from the ESPN/ERA-EDTA Registry. Am J Transplant. 2016;16(7):2097-2105. https://doi.org/10.1111/ajt.13723 PMID:26783738 DOI: https://doi.org/10.1111/ajt.13723
Bikbov B, Perico N, Remuzzi G; on behalf of the GBD Genitourinary Diseases Expert Group. Disparities in Chronic Kidney Disease Prevalence among Males and Females in 195 Countries: Analysis of the Global Burden of Disease 2016 Study. Nephron. 2018;139(4):313-318. https://doi.org/10.1159/000489897 PMID:29791905 DOI: https://doi.org/10.1159/000489897
Vinson AJ. Gender Disparities in Access to kidney Transplant: inequities in the inequity. Kidney Int Rep. 2022;7(6):1145-1148. https://doi.org/10.1016/j.ekir.2022.03.034 PMID:35694565 DOI: https://doi.org/10.1016/j.ekir.2022.03.034
Natale P, Hecking M, Kurnikowski A. et al. Perspectives of Nephrologists on Gender Disparities in Access to Kidney Transplantation. Clinical Journal of the American Society of Nephrology. 2023 https://doi.org/10.2215/CJN.0000000000000238. DOI: https://doi.org/10.2215/CJN.0000000000000238
Katz-Greenberg G, Shah S. Sex and gender differences in kidney transplantation. Semin Nephrol. 2022;42(2):219-229. https://doi.org/10.1016/j.semnephrol.2022.04.011 PMID:35718368 DOI: https://doi.org/10.1016/j.semnephrol.2022.04.011
Carrero JJ, Hecking M, Chesnaye NC, Jager KJ. Sex and gender disparities in the epidemiology and outcomes of chronic kidney disease. Nat Rev Nephrol. 2018;14(3):151-164. https://doi.org/10.1038/nrneph.2017.181 PMID:29355169 DOI: https://doi.org/10.1038/nrneph.2017.181
Kurnikowski A, Krenn S, Lewandowski MJ, et al. Country-specific sex disparities in living kidney donation. Nephrol Dial Transplant. 2022;37(3):595-598. https://doi.org/10.1093/ndt/gfab305 PMID:34669961 DOI: https://doi.org/10.1093/ndt/gfab305
Segev DL, Kucirka LM, Oberai PC, et al. Age and comorbidities are effect modifiers of gender disparities in renal transplantation. J Am Soc Nephrol. 2009;20(3):621-628. https://doi.org/10.1681/ASN.2008060591 PMID:19129311 DOI: https://doi.org/10.1681/ASN.2008060591
Vilayur E, van Zwieten A, Chen M, et al. Sex and gender disparities in living donation: a scoping review. Transplant Direct. 2023;9(9):e1530. https://doi.org/10.1097/TXD.0000000000001530 PMID:37636486 DOI: https://doi.org/10.1097/TXD.0000000000001530
Puoti, F., Ricci, A., Nanni-Costa, A. et al. Organ transplantation and gender differences: a paradigmatic example of intertwining between biological and sociocultural determinants. Biol Sex Differ 7, 35 (2016). https://doi.org/10.1186/s13293-016-0088-4 DOI: https://doi.org/10.1186/s13293-016-0088-4
Gill J, Joffres Y, Rose C, et al. The Change in Living Kidney Donation in Women and Men in the United States (2005-2015): A Population-Based Analysis. J Am Soc Nephrol. 2018;29(4):1301-1308. https://doi.org/10.1681/ASN.2017111160 PMID:29519800 DOI: https://doi.org/10.1681/ASN.2017111160
Lepeytre F, Dahhou M, Zhang X, et al. Association of Sex with Risk of Kidney Graft Failure Differs by Age. J Am Soc Nephrol. 2017;28(10):3014-3023. https://doi.org/10.1681/ASN.2016121380 PMID:28592422 DOI: https://doi.org/10.1681/ASN.2016121380
Meier-Kriesche HU, Ojo AO, Leavey SF, et al. Gender differences in the risk for chronic renal allograft failure. Transplantation. 2001;71(3):429-432. https://doi.org/10.1097/00007890-200102150-00016 PMID:11233906 DOI: https://doi.org/10.1097/00007890-200102150-00016
Momper JD, Misel ML, McKay DB. Sex differences in transplantation. Transplant Rev (Orlando). 2017;31(3):145-150. https://doi.org/10.1016/j.trre.2017.02.003 PMID:28262425 DOI: https://doi.org/10.1016/j.trre.2017.02.003
Velicković-Radovanović R, Mikov M, Paunović G, et al. Gender differences in pharmacokinetics of tacrolimus and their clinical significance in kidney transplant recipients. Gend Med. 2011;8(1):23-31. https://doi.org/10.1016/j.genm.2011.01.003 PMID:21497769 DOI: https://doi.org/10.1016/j.genm.2011.01.003
Spasić A, Catić-Đorđević A, Veličković-Radovanović R, Stefanović N, Džodić P, Cvetković T. Adverse effects of mycophenolic acid in renal transplant recipients: gender differences. Int J Clin Pharm. 2019;41(3):776-784. https://doi.org/10.1007/s11096-019-00837-z PMID:31028595 DOI: https://doi.org/10.1007/s11096-019-00837-z
Tornatore KM, Meaney CJ, Wilding GE, et al. Influence of sex and race on mycophenolic acid pharmacokinetics in stable African American and Caucasian renal transplant recipients. Clin Pharmacokinet. 2015;54(4):423-434. https://doi.org/10.1007/s40262-014-0213-7 PMID:25511793 DOI: https://doi.org/10.1007/s40262-014-0213-7
National Institutes of Health Office of Research on Women’s Health,. NIH Policy on sex as a biological variable. Online https://orwh.od.nih.gov/sex-gender/nih-policy-sex-biological-variable (Accessed September 2023)
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Accepted 2023-10-04
Published 2023-10-17
