Unraveling Sex Differences in Kidney Health and Chronic Kidney Disease: a Review of the Impact of Sex Hormones

Sexual dimorphism plays an important role in the pathogenesis and progression of chronic kidney disease (CKD). Men with CKD often exhibit faster kidney function decline, leading to higher rates of kidney failure and mortality compared to women. Studies suggest that sex hormones may influence this apparent dimorphism, although the mechanisms underlying these influences remain poorly understood. In this review, we first summarize recent findings on sex differences in the prevalence and progression of CKD. Subsequently, we will focus on (1) the role of sex hormones in these sex differences, (2) kidney structural and hemodynamic differences between men and women, (3) the influence of sex hormones on pathophysiological processes leading to kidney disease, including glomerular hyperfiltration and key pathways involved in kidney inflammation and fibrosis, and finally, focus on the consequences of the underrepresentation of women in clinical trials. Understanding these sex differences is critical for advancing precision medicine and improving outcomes for both men and women with CKD.