Chronic kidney disease in women and men Exploring differences by sex, gender and ethnicity

Chronic kidney disease (CKD) is a progressive disease that affects millions worldwide. Prior studies in Europe and the Netherlands show that women generally have a higher prevalence of CKD compared to men. Meanwhile, men often experience faster kidney function decline and CKD progression compared to women. Women and men from ethnic minority groups have been underrepresented in these studies, yet face a disproportionate burden of CKD. 
Part 1 examines the overall occurrence and progression of CKD in women and men and across ethnic groups, while determining the contribution of traditional CKD risk factors to sex differences. In part 2, the analyses focus on whether CKD is detected equally in women and men. Part 3 includes an investigation of the association of several sex and gender-related factors with CKD.
This thesis concludes that patterns of CKD are not similar in women and men across all ethnic groups. This was evident across several kidney function-related outcomes. Furthermore, this thesis shows that current CKD detection approaches are sub optimally identifying women, likely due to differing risk factors and impact of risk factors. The results of this thesis also suggest that sex and gender factors may contribute to CKD in some subgroups of women and men, such as social- and employment-related factors. However, further research is necessary to confirm these findings and understand the underlying mechanisms driving the observed associations. Nevertheless, taken together, the work has identified starting points for the development of CKD interventions while adding a piece to the puzzle to understand differences in CKD and strengthen the evidence base for prevention between women and men.