How Glomerular Disease Shapes Young Women's Life Choices, With Sayna Norouzi, MD

Women with chronic kidney disease (CKD) are diagnosed later than men and are less likely to begin dialysis or receive a kidney transplant, according to a new American Heart Association (AHA) scientific statement published in Circulation.¹ For women diagnosed young with a rare or autoimmune kidney disease, one of the statement’s co-authors says the burden of CKD begins long before those endpoints.

“This is a topic that is really close to my heart because it’s focused on women’s kidney health. So the fact that we are paying more attention to women’s kidney health and it’s coming from AHA, it’s huge,” Sayna Norouzi, MD, assistant professor of medicine and clinical nephrologist at Loma Linda University Medical Center and director of its Glomerular and Polycystic Kidney Diseases Clinics, said in an interview with HCPLive.

Why CKD Is Diagnosed Later and Treated Less Often in Women

CKD affects about 1 in 10 women worldwide, but the condition may go unrecognized longer in women than in men.¹˒² Kidney function is typically estimated using creatinine, and because women tend to have less muscle mass and produce less creatinine, those estimates may not accurately reflect their kidney function. As a result, some cases are misclassified or caught later.²

That delay carries through to treatment. Women tend to begin dialysis at a lower level of kidney function than men, and globally, men receive kidney transplants about 30% more often than women. In some low and middle income countries, the gap exceeds 10 to 1.² The authors cite caregiving responsibilities, cultural expectations, limited health literacy, and treatment costs as barriers that may keep women from reaching specialist care.²

Female-Specific Risk Factors for CKD Across the Lifespan

The statement frames kidney health as closely tied to reproductive health at every life stage. Preeclampsia and other pregnancy complications may signal greater future risk of kidney disease, heart disease, and stroke, while natural menopause before age 45 and surgical removal of the ovaries before age 50 are each linked with a greater risk of CKD.²

Polycystic ovary syndrome and lupus, which is more common in women than men, are also associated with greater CKD risk. Among people with diabetes, the leading cause of CKD worldwide, some evidence suggests women may progress to kidney failure at higher rates than men.²

Family Planning After an IgA Nephropathy or Lupus Nephritis Diagnosis

For Norouzi, the women most affected by these gaps are often those with glomerular and autoimmune kidney diseases. Patients with IgA nephropathy or lupus nephritis are frequently diagnosed young, she said, which means the effects of CKD extend well beyond eventual dialysis or transplant and shape how they navigate life from the point of diagnosis.

In her clinic, which includes patients with lupus nephritis, IgA nephropathy, and C3 glomerulopathy, those concerns surface almost immediately. “The moment we talk about chronic kidney disease, they’re going to ask questions about how they’re going to have a family, if they can get pregnant, if they can have kids,” she said. Patients also ask whether they should get married and whether to tell a partner about their diagnosis, Norouzi added, questions that lead her to wonder whether clinicians are paying enough attention to the burden of CKD in women.

The statement supports bringing those conversations into routine care. Pregnancy in women with CKD may increase the risk of disease progression and pregnancy complications, and managing blood pressure, blood sugar, and body weight is suggested for women with CKD planning a pregnancy. The authors recommend embedding reproductive health assessment into CKD care as a step toward more precise kidney medicine.²

Closing the Evidence Gap for Women With CKD

Women remain underrepresented in CKD trials, and few studies report results by sex, which limits how well the evidence applies to women.³ Women may also respond differently to kidney therapies because of differences in how drugs are absorbed, distributed, metabolized, and cleared.² The statement calls for enrolling enough women in trials to detect differences in treatment effects, reporting results by sex and reproductive health factors, and studying sex-specific pharmacokinetics and pharmacodynamics to guide dosing and drug selection.²˒³

For Norouzi, better evidence needs to translate into better support for patients over the long term.

“Yes, there are endpoints of ending up on dialysis and transplant, but how getting diagnosed with CKD is going to affect their life choices, and how they’re going to navigate life after being diagnosed with rare disease and CKD at such a young age, that’s something that we should pay more attention to and come up with better solutions for our patients on how to navigate CKD and complications throughout life,” she said.

Editors’ note: Norouzi reports relevant disclosures with Calliditas, Travere, Apellis and others.

References

1. Gohar EY, Shah S, Oh ES, et al. Women’s kidney health in focus: a scientific statement from the American Heart Association. Circulation. Published online September 17, 2026. doi:10.1161/CIR.0000000000001471

2. American Heart Association. Women’s kidney health may be overlooked, delaying critical prevention and treatment opportunities. News release. September 17, 2026. Accessed October 8, 2026. https://newsroom.heart.org/news/womens-kidney-health-may-be-overlooked-delaying-critical-prevention-and-treatment-opportunities

3. American Heart Association. Women’s kidney health in focus. Science News. September 17, 2026. Accessed October 8, 2026. https://professional.heart.org/en/science-news/womens-kidney-health-in-focus