Women with chronic kidney disease are less likely than men to be diagnosed, represented in research and given treatments that have been properly tested in them. That is the central finding of a major new paper published today in The Lancet, which warns that decades of male-dominated clinical research have left women systematically disadvantaged at every stage of the disease. Chronic kidney disease already affects 844 million adults worldwide and is projected to become the fifth leading cause of death globally by 2040.
The finding is among a series of stark warnings contained in a landmark three-paper Lancet series released today. The series, led by Dr Jennifer Lees from the University of Glasgow and involving researchers from around the world, finds that up to 30 to 50 per cent of CKD cases go undiagnosed in high-income countries. Non-white people and women may be up to twice as likely to remain undiagnosed as white men, and nine in ten people with a recorded diagnosis are unaware they have the condition. The series is released as up to 10,000 kidney experts gather in Glasgow for the European Renal Association Congress from 3 to 6 June.
Dr Sradha Kotwal, Program Head of Renal and Metabolic at The George Institute for Global Health, co-authored the paper, which examines how being biologically female shapes the experience of kidney disease at every level, from how the kidneys work to how the body processes medication.
"Chronic kidney disease is already one of the most underdiagnosed conditions globally but our research shows women face an additional layer of disadvantage. 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.
By:Dr Sradha Kotwal
Program Head, Renal and Metabolic Division
In Australia, local data reinforces this picture. A 2025 study of Australian general practice records, published in The Lancet Regional Health - Western Pacific, found that women were less likely than men to be tested for kidney disease, referred to a specialist or given cardiovascular risk management, even when their test results were comparable.
Fewer than 45 per cent of participants in kidney disease clinical trials are women, a figure that drops to just one in three in recent trials of some of the most important new drug classes in kidney medicine. No major kidney disease trial has ever broken down its safety results by sex to understand whether a drug is equally safe for women and men. This means that for many treatments currently used in Australia and around the world, the risks and benefits for women are simply unknown.
The consequences are real. In one trial, the drug atrasentan offered women greater kidney protection than men but also caused more heart failure events in women, a difference that only emerged when results were analysed separately by sex. In another, the drug obinutuzumab produced substantially better outcomes in women with lupus nephritis, while men fared better without treatment entirely.
Women who are pregnant face particular risk, as signs of kidney disease including protein in the urine are frequently mistaken for other conditions, delaying diagnosis at a critical time. Between 3 and 6 per cent of women of reproductive age are estimated to have pre-existing kidney disease, yet routine pregnancy checks do not test for it.
The authors call on governments, research funders, medical journals and clinicians to make the study of sex differences a routine part of how kidney disease is researched and treated, both in Australia and globally.
"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. This is a call to everyone in the system to make sex differences a standard part of how we think about kidney health.
By:Dr Sradha Kotwal
Program Head, Renal and Metabolic Division
DOI link - https://doi.org/10.1016/S0140-6736(26)00654-9
