Women with kidney disease left behind from bench to bedside

Women with chronic kidney disease are being systematically overlooked at every stage of care, according to a major new analysis that warns decades of male-dominated research have left women at a significant disadvantage.

The research, unveiled at the European Renal Association Congress, found that women are less likely than men to be diagnosed with chronic kidney disease, represented in clinical trials, referred to specialist care or receive treatments that have been adequately tested in female populations.

Dr Sradha Kotwal, Program Head of Renal and Metabolic at The George Institute for Global Health and co-author of the paper, said the disparities expose a persistent blind spot in kidney care.

“Chronic kidney disease is already one of the most underdiagnosed conditions globally but our research shows women face an additional layer of disadvantage,” she said. “Even when the signs are there, they are less likely to be tested, less likely to be referred and less likely to receive the treatments they need. We cannot continue to treat kidney disease as a one-size-fits-all condition.”

Australian data reflects the global trend. A 2025 study examining general practice records found women were less likely than men to be tested for kidney disease, referred to specialist care or receive cardiovascular risk management, even when their clinical test results were comparable.

The inequities extend into clinical research. Women account for fewer than 45% of participants in kidney disease clinical trials, with representation falling to just one-third in recent studies evaluating some of the most significant new drug classes in nephrology. The paper also highlights that no major kidney disease trial has ever reported safety outcomes separately by sex, leaving critical questions unanswered about whether therapies are equally safe for women and men.

Evidence suggests those differences can be clinically significant.

In one trial, the Novartis’ drug Vanrafia (atrasentan) provided greater kidney protection for women than men but was also associated with higher rates of heart failure events among women, a distinction that only became apparent after researchers analysed the data by sex. In another study, Roche’s Gazyva (obinutuzumab) delivered substantially better outcomes for women with lupus nephritis, while men experienced better outcomes without treatment.

The findings come as Australia’s dialysis network system faces mounting operational pressures, with a separate report revealing widespread capacity constraints across dialysis services.

Data jointly released by the Australian and New Zealand Society of Nephrology (ANZSN), the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry and the New Zealand National Clinical Renal Network, found that more than 80% of renal units reported dialysis waiting lists while 24% had dialysis machines out of service. Several jurisdictions were already operating above normal capacity, with regional and remote communities experiencing the greatest strain.

Against this backdrop, industry leaders are warning that expanding traditional service models will not be enough to meet growing demand.

“More funding alone will not keep pace with rising demand for dialysis. Health systems must rapidly shift to smarter, more flexible home-based models of care that unlock capacity now,” Matthew Bain, General Manager of Vantive in Australia and New Zealand told Health Industry Hub. “Innovation in delivery, particularly through home dialysis and integrated technologies – including remote patient management – are essential to urgently and sustainably meet the growing dialysis burden.”

“Scaling home dialysis is critical and urgent to reduce pressure on overstretched systems while giving patients greater independence and quality of life. Adoption is still held back by workforce, infrastructure and awareness barriers, which must be addressed through coordinated action across policy, clinical practice and innovation,” Bain added.

In response to the findings presented at the European Renal Association Congress, The George Institute for Global Health is calling on governments, research funders, medical journals and clinicians to make the study of sex differences a routine component of kidney disease research and clinical practice.

“We now have better treatments for kidney disease than at any point in history, but women will not benefit equally from those advances unless we fundamentally change how we design research, analyse data and deliver care,” Dr Kotwal emphasised. “This is a call to everyone in the system to make sex differences a standard part of how we think about kidney health.”

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