18 SEP 2026 — Chronic kidney disease affects about one woman in ten worldwide. Men receive kidney transplants roughly 30 per cent more often than women, and in some low- and middle-income countries the gap is wider than ten to one.
Those figures come from a scientific statement the American Heart Association published in Circulation on 17 September, drawing together what is known about women's kidney health and what is not.
What kind of document this is
A scientific statement is not a trial. It reports no new patients and generates no new data. It is a writing group reading the existing evidence and saying, with the association's name attached, what that evidence supports and where it runs out.
The document's form is what gives the numbers their weight. The transplant disparity is not a new finding. It is an established pattern restated by a body with the standing to make clinicians act on it.
The group is chaired by Eman Y. Gohar of Vanderbilt University Medical Center, with Silvi Shah as vice-chair and ten further co-authors.
The gap in who gets an organ
The thirty per cent difference in transplant rates is the statement's sharpest number. The ten-to-one figure from some low- and middle-income countries is the one that should trouble readers in this region most.
Transplant access is not a single decision. It is referral, evaluation, listing, a living donor or a deceased one, and the ability to pay for immunosuppression afterwards. A disparity that survives all of those stages is not explained by any one of them, and the statement does not claim to have isolated a cause.
Dialysis access shows the same direction. Women are less likely to receive it, in a disease where the alternative to treatment is death.
Why the tests miss it
The diagnostic argument is the more technical half. Gohar puts the principle bluntly: "Women are not simply smaller versions of men. Their biology, reproductive life stages and responses to medication may differ."
She adds that many cases go undiagnosed in women because common tests and research do not always reflect women's biology and life stages. Kidney function is generally estimated rather than measured directly, from equations built on creatinine, which depends on muscle mass. Applying an estimate calibrated on one population to another does not fail loudly. It returns a number that looks normal.
The statement names menstrual health, pregnancy and the postpartum period, and autoimmune disease as female-specific factors bearing on kidney and cardiovascular health across a lifetime, alongside social and cultural factors affecting who reaches care at all.
What it asks for
The statement asks for three things, all modest by design. Include reproductive health assessment in chronic kidney disease care. Increase women's enrolment in clinical trials, where they remain under-represented. Analyse results by sex rather than pooling them.
The third compounds. A trial that does not report sex-specific results cannot tell a clinician whether a drug behaves differently in women, and every subsequent guideline inherits that silence. So a gap persists without anyone deciding to create it.
None of this requires new technology. It requires study design and clinical habit, which are cheaper to change and harder to make anyone change.
What to watch
The substantive test will be whether the estimating equations change. Kidney function estimates have been revised before when the inputs were shown to encode something other than physiology, and the statement's diagnostic argument points at the same class of problem.
Trial reporting is the measurable part. Sex-specific analysis can be checked from outside: it either appears in published results or it does not. The effect of a statement like this shows up there within a few years, or not at all.
The regional question is whether the disparity figures get local numbers. The ten-to-one transplant gap is attributed to low- and middle-income countries as a group, which spans very different health systems. Our reporting on the cardiovascular-kidney-metabolic signature found in childhood covered the same organ system from the other end of life; both lines of work need cohorts from this region before anyone can say what the pattern looks like here.
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