The global burden of chronic kidney disease in women and its metabolic–cardiovascular links
Study highlights increasing chronic kidney disease in women, driven by metabolic disorders and associated with major cardiovascular health challenges
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Age-standardized prevalence (A), mortality (B), and disability-adjusted life-years (C) rates of chronic kidney disease among women in 1990 and 2021, and their average annual percentage changes (D), stratified by age group (0–14, 15–49, and ≥50 years). Postmenopausal women (≥50 years) bore the heaviest and still-rising burden, while reproductive-age women (15–49 years) showed a slow but persistent rise in prevalence—two populations at the center of the global CKD trend in women.
view moreCredit: Prof. Lin Sun and Prof. Zhifeng Sheng from The Second Xiangya Hospital of Central South University Image link: https://www.ovid.com/jnls/cmj/fulltext/10.1097/cm9.0000000000004100~chronic-kidney-disease-in-women-global-trends-and
Chronic kidney disease is now the seventh leading cause of death among noncommunicable diseases globally, affecting 11–13% of the adult population. While women consistently show a higher prevalence of CKD than men, most epidemiological analyses have pooled the sexes together, leaving the distinct patterns of CKD in women poorly understood. Women also face unique biological vulnerabilities—from faster disease progression after menopause to intergenerational risks linked to pregnancy complications—that demand tailored attention.
To address these gaps, Professor Lin Sun and Professor Zhifeng Sheng from The Second Xiangya Hospital of Central South University conducted the first global analysis dedicated to CKD in women. Drawing on Global Burden of Disease 2021 data, the team quantified trends by age, CKD subtype, sociodemographic level, and risk factor, and further examined the cardiovascular consequences of impaired kidney function. Their findings were published in the Chinese Medical Journal on June 1, 2026.
1. CKD in Women: An Underestimated "Silent Killer"
“Our analysis shows that the burden of CKD in women has not only grown, but has also transformed in character. Metabolic drivers—diabetes, hypertension, and obesity—now shape the trajectory of the disease,” explains Prof. Sun. The number of women living with CKD climbed from about 188 million in 1990 to 359 million in 2021. Over the same period, deaths from CKD in women rose by 180.89%, and disability-adjusted life years (DALYs) increased by 114.00%. The age-standardized mortality and DALY rates both showed continuous upward trends, underscoring the worsening severity of the disease even after accounting for population growth and aging.
2. Reproductive-Age and Postmenopausal Women Bear the Major Burden
The study identified two populations at the heart of this global trend. Postmenopausal women (aged 50 years and older) bore the heaviest burden, accounting for nearly 90% of CKD-related deaths and about 73% of DALYs among women in 2021; both their age-standardized mortality rate (64.03 per 100,000) and DALY rate (1,493.31 per 100,000) continued to rise over the 32-year period. At the same time, women of reproductive age (15–49 years) emerged as a fast-growing risk group: their prevalent cases increased by 64.01%, and, uniquely among age groups, their age-standardized prevalence rate continued to climb (average annual percentage change, 0.13%).
3. From Risk to Heart: Metabolic and Behavioral Drivers Are Modifiable Targets
Metabolic kidney disease showed the most alarming trajectory. Type 2 diabetic kidney disease recorded the largest increase in age-standardized mortality among all CKD subtypes (+36.93%), and hypertensive kidney disease prevalence effectively doubled. Metabolic risk factors—high fasting plasma glucose, high systolic blood pressure, and high body mass index—were the dominant attributable risks across all ages, with their combined impact approximately twice as large in women aged 50 and older as in younger women. Among reproductive-age women, the attributable burden linked to high body mass index more than doubled (+112.17%) and that linked to sugar-sweetened beverages rose by 132.97%, pointing to a widening metabolic vulnerability that begins well before midlife.
4. Demographic Drivers: Population Growth and Aging Accelerate the CKD Burden in Women
In 2021, cardiovascular disease attributable to impaired kidney function in women accounted for 18.19 million DALYs—about 46.70% of the total burden of kidney dysfunction in this population. Ischemic heart disease alone contributed roughly 60% of this cardiovascular burden, followed by cerebral hemorrhage and ischemic stroke. Geographical disparities were pronounced: women in low and low-middle sociodemographic regions carried the highest CKD burden, while high-income North America showed the fastest growth in CKD-related mortality. Decomposition analysis revealed that population growth (58.63%) and population aging (26.64%) were the principal engines driving the global rise in CKD-related DALYs.
5. Conclusion
“Women face a converging metabolic–renal–cardiac threat that unfolds across the life course,” concludes Prof. Sun. “Integrating kidney screening into preconception and antenatal care, tightening control of obesity, glucose, and blood pressure from young adulthood, and expanding access to kidney-protective therapies such as sodium–glucose cotransporter 2 inhibitors in low-resource settings will be essential to bend this curve.” The authors call for sex-specific CKD registries, multidisciplinary cardio-kidney-metabolic clinics, and policy investment in women’s kidney health as urgent next steps.
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Reference
DOI: 10.1097/CM9.0000000000004100
About Prof. Lin Sun from The Second Xiangya Hospital of Central South University
Prof. Lin Sun is a leading nephrologist at the Department of Nephrology, The Second Xiangya Hospital of Central South University, and a principal investigator at the Hunan Key Laboratory of Kidney Disease and Blood Purification in Changsha, China. His research focuses on the pathogenesis and prevention of diabetic kidney disease, metabolic kidney injury, and the cardio-renal–metabolic axis. He has led multiple projects funded by the National Natural Science Foundation of China and has published extensively in leading nephrology and internal medicine journals. His current work emphasizes translating population-level evidence into sex-specific and life-course strategies for kidney disease prevention.
About Prof. Zhifeng Sheng from The Second Xiangya Hospital of Central South University
Prof. Zhifeng Sheng is a clinician-scientist at the Health Management Center and the Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University. He directs research at the Hunan Provincial Clinical Medicine Research Center for Intelligent Management of Chronic Disease and the Hunan Provincial Key Laboratory of Metabolic Bone Diseases.
Funding information
This work was supported by the National Natural Science Foundation of China (Grant No. 82370730) and the Hunan Provincial Clinical Medicine Research Center for Intelligent Management of Chronic Disease (2023SK4042).
Journal
Chinese Medical Journal
Method of Research
Data/statistical analysis
Subject of Research
People
Article Title
Chronic kidney disease in women: Global trends and metabolic-cardiovascular associations
Decomposition analysis of the changes in disability-adjusted life-years (DALYs) attributable to chronic kidney disease (CKD) among women across 21 global regions, 1990–2021. Each horizontal bar decomposes the total change into contributions from population growth, population aging, and epidemiological changes across five CKD subtypes (type 1 diabetic kidney disease [T1DM-CKD], type 2 diabetic kidney disease [T2DM-CKD], hypertensive kidney disease [HT-CKD], glomerulonephritis [GN-CKD], and other causes). Globally, population growth (58.63%) and aging (26.64%) were the principal drivers of the rising CKD burden in women. Patterns varied markedly by region: South Asia and Central Latin America showed the largest overall increases, driven mainly by population growth; East Asia and high-income Asia-Pacific were dominated by aging, with negative epidemiological contributions across all CKD subtypes; and Sub-Saharan African regions were fueled predominantly by population growth.
Credit
Prof. Lin Sun and Prof. Zhifeng Sheng from The Second Xiangya Hospital of Central South University Image link: https://www.ovid.com/jnls/cmj/fulltext/10.1097/cm9.0000000000004100~chronic-kidney-disease-in-women-global-trends-and
Widespread women's disease takes a mental toll – before and after diagnosis
A large Danish study shows that women with endometriosis use more anxiety and depression medication than others – as early as ten years before they receive their diagnosis.
Women who are later diagnosed with endometriosis have a markedly higher use of antidepressant and anxiety medication, and are far more often in contact with psychiatric hospital departments than other women.
And this is not only the case after the diagnosis has been made. The pattern is already apparent ten years before.
That is the finding of a large new Danish registry-based study from Aarhus University, based on data from 136,842 women.
"What surprised us was how clear and persistent the pattern was, and that the difference did not diminish over time. On the contrary. Women with endometriosis consistently redeemed more prescriptions for antidepressant medication than women without the disease throughout the entire period, from ten years before to ten years after diagnosis," says Marie Josiasen, PhD student at the Department of Public Health and one of the researchers behind the study.
The difference appears ten years earlier
Specifically, women with endometriosis redeemed 29 percent more prescriptions for antidepressant medication and 16 percent more for anxiety medication in the years before diagnosis.
After diagnosis, the difference rose to 40 and 46 percent.
The study does not provide an answer as to what causes the mental strain, but Marie Josiasen points to a couple of likely explanations:
"It's possible that prolonged pain, uncertainty about the cause of the symptoms, and frustration over not being able to live the life one wants may be among the reasons. For some women, fertility problems can also be a major psychological burden," she says.
A hard realization
One of the study's most interesting findings, according to Marie Josiasen, is that the strain does not ease after the women receive their diagnosis.
On the contrary, the difference compared with women without endometriosis becomes even more pronounced in the years that follow.
"A diagnosis can be a relief, but it also involves coming to terms with having a chronic illness," says Marie Josiasen.
The study does not indicate whether an earlier diagnosis could reduce the psychological strain.
As part of her PhD project, Marie Josiasen will investigate the role that hormonal contraception plays in the mental health of women with endometriosis.
"We can see that many receive medication and are in contact with psychiatric services. But we still lack an understanding of what actually helps these women. That's what I want to help find out," says Marie Josiasen.
Behind the research
Study type: Registry-based study
Collaborators:
External funding: This study is supported by grants from the project "Finding Endometriosis using Machine Learning," funded by the European Union's Horizon 2020 research and innovation programme, and by Helsefonden.
Potential conflicts of interest: The authors declare no conflicts of interest.
Link to the scientific article: https://doi.org/10.1093/humrep/deag089
Journal
Human Reproduction
Method of Research
Data/statistical analysis
Subject of Research
People
Article Title
Endometriosis and the mental health burden: a registry-based study of redeemed prescriptions and psychiatric hospital contacts before and after diagnosis of endometriosis
Article Publication Date
18-Aug-2026
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