Improved understanding of sex and gender-specific differences in the aetiology, mechanisms and epidemiology of chronic kidney disease (CKD) could help nephrologists better address the needs of their patients. Population-based studies indicate that CKD epidemiology differs by sex, affecting more women than men, especially with regard to stage G3 CKD. The effects of longer life expectancy on the natural decline of glomerular filtration rate (GFR) with age, as well as potential overdiagnosis of CKD through the inappropriate use of GFR equations, might be in part responsible for the greater prevalence of CKD in women. Somewhat paradoxically, there seems to be a preponderance of men among patients starting renal replacement therapy (RRT); the protective effects of oestrogens in women and/or the damaging effects of testosterone, together with unhealthier lifestyles, might cause kidney function to decline faster in men than in women. Additionally, elderly women seem to be more inclined to choose conservative care instead of RRT. Dissimilarities between the sexes are also apparent in the outcomes of CKD. In patients with predialysis CKD, mortality is higher in men than women; however, this difference disappears for patients on RRT. Although access to living donor kidneys among men and women seems equal, women have reduced access to deceased donor transplantation. Lastly, health-related quality of life while on RRT is poorer in women than men, and women report a higher burden of symptoms. These findings provide insights into differences in the underlying pathophysiology of disease as well as societal factors that can be addressed to reduce disparities in access to care and outcomes for patients with CKD.

更好地了解慢性肾脏病（CKD）的病因，机制和流行病学上的性别和性别特定差异，可以帮助肾脏病学家更好地满足患者的需求。基于人群的研究表明，CKD流行病学在性别方面有所不同，影响女性的人数多于男性，尤其是在G3期CKD阶段。预期寿命延长对肾小球滤过率（GFR）随年龄自然下降的影响，以及由于不适当使用GFR方程而可能对CKD进行过度诊断的部分原因可能是女性CKD患病率更高的部分原因。有点自相矛盾的是，开始进行肾脏替代治疗（RRT）的患者中男性占多数。雌激素对女性的保护作用和/或睾丸激素的破坏作用，加上不健康的生活方式，可能导致男性的肾功能下降快于女性。此外，老年妇女似乎更倾向于选择保守治疗而不是RRT。在CKD的预后中，性别之间的差异也很明显。在透析前CKD患者中，男性的死亡率高于女性。但是，使用RRT的患者这种差异消失了。尽管在男女之间获得活体供体肾脏的机会似乎相等，但妇女减少了已故供体移植的机会。最后，在接受RRT期间与健康相关的生活质量方面，女性比男性差，并且女性报告的症状负担更高。