Women's health

Kidney disease in midlife: why it’s an overlooked women’s health concern

From heart disease to osteoporosis, research shows that women become more susceptible to various significant health conditions as we age. But there’s one concern that’s often overlooked, despite the fact an estimated 22% of adults over the age of 35 have it: chronic kidney disease (CKD).

What does chronic kidney disease involve?

CKD is when our kidneys become damaged and don’t work as well as they should.

“If your kidneys aren’t functioning properly, over time, it can lead to end-stage renal disease (ESRD),” says Dr Sam Wild, Clinical Lead for Women’s Health at Bupa Health Clinics. “ESRD may mean you need renal dialysis or a kidney transplant.”

There are five stages to CKD, with stages 1-3a considered early and 3b-5 moderate to severe.

Unfortunately, individuals may not realise they have CKD until significant damage has occurred.

“Kidney disease often doesn’t have symptoms in [its] early stages,” explains Sam. “Unless it’s discovered through routine tests for other conditions, it’s unlikely that you’ll know you have kidney disease until it’s at a later stage.”

Dr Wild says that later-stage CKD symptoms include:

Blood in the urine
Needing to pee more often, especially at night
Weight loss with no clear reason
Feeling tired for no apparent reason
Poor appetite
Swelling in the hands, ankles, or feet
Headaches
Difficulty sleeping
Shortness of breath
Skin feeling itchy
Nausea
Muscle cramps

CKD isn’t a stand-alone concern and has a reciprocal relationship with many other health issues. For instance, those with end-stage CKD are 20 times more likely to die from cardiovascular disease, while around 40% of people with diabetes develop CKD.

“Because [CKD] is silent, we recommend that women who have conditions that put them at greater risk –- such as diabetes, hypertension, cardiovascular disease, and urological problems – have a regular kidney health check,” states Dr Richard Hull, a Consultant Kidney Specialist at Nuffield Health Parkside Hospital. These checks are straightforward, involving a blood test and urine sample to determine if the kidneys are leaking any proteins.

Risk factors for chronic kidney disease

Our likelihood of developing CKD increases with age; around half of those aged 75 and over experience the disease. In women, various factors contribute to heightened risk as the years tick by – including menopause.

Declining oestrogen levels can lead to everything from mood swings, night sweats, and weight gain – but hormonal decreases can also impact our kidneys.

“Oestrogen has been suggested to have anti-inflammatory and antioxidative effects, which help protect kidney function,” says Richard. This means that, with lower hormone levels, our kidneys are more susceptible to damage.

Reduced levels of oestrogen can also encourage vaginal dryness and tissue thinning, leading to increased occurrence of urinary tract infections (UTIs). “If you have frequent UTIs, it can leave you at greater risk of kidney damage,” Sam notes. “Women are also more likely [than men] to get a worse type of UTI called pyelonephritis.”

Even before reaching midlife, other factors can heighten a woman’s chance of developing CKD. Pregnancy-related concerns – including high blood pressure, pre-eclampsia, and gestational diabetes – can negatively impact the kidneys, reveals Dr Kristin Veighey, an NIHR Academic Clinical Fellow in General Practice at the University of Southampton and University Hospitals NHS Trust and a Consultant Nephrologist.

Kristin adds that women are also more affected by certain inflammatory or autoimmune diseases, such as lupus, and these are known to affect the kidneys.

In many instances, however, CKD occurs as part of the natural ageing process. “Kidney function naturally declines with age,” says Kristin. “The majority of CKD in older women will relate to the natural progression of damage to the very small blood vessels within the kidneys.”

Protecting against kidney disease

While the ageing process and menopause are out of our control, there are weapons we can add into our wellbeing arsenal to help protect our kidneys.

Follow a healthy lifestyle

An oldie but a goodie, the experts recommend it for a reason. “For most people, eating a healthy and balanced diet, exercising, not smoking, and moderating alcohol intake (<14 units/week) will be the main ways to protect their kidneys and overall health,” Kristin shares.

Don’t leave UTIs untreated

When left to their own devices, UTIs can spread to the kidneys, causing infection and damage. “If you develop a urine infection, seek advice from a health professional straight away,” recommends Sam.

Be vigilant if you have an underlying health condition

Kristin says that those with an existing condition known to be associated with CKD – such as high blood pressure, diabetes, or lupus – should have their kidney function tested by their GP at least once a year. The same applies if kidney disease runs in your family.

Attend your health checks

As CKD typically goes unnoticed in the earlier stages, routine health tests can prove vital in detecting developing concerns.

“NHS Health Checks, offered every five years by GPs to those aged 40-74, are a good way for people who don’t have a specific condition to be screened for kidney disease,” says Kristin.

What happens if we develop kidney disease?

If a test indicates that we have some level of CKD, it’s important not to panic. Many cases of early stage CKD don’t develop to a more severe stage. Although we can’t reverse damage that’s already occurred, numerous treatments are available depending on our stage of CKD.

Richard says the primary treatment tactic for the majority of CKD cases involves tackling the issue causing kidney damage. This helps to slow CKD progression and minimise its effects. For example, if high blood pressure is the main contributor, ACE inhibitor drugs and angiotensin receptor blockers are commonly prescribed.

The good news is that new treatments are developing all the time. “[This] includes SGLT-2 inhibitors, which are now used widely in treatment as they have proven renal protective and cardiovascular protective benefits,” Richard shares. Kristin adds that SGLT-2 inhibitors can help to extend kidney function by up to a decade if started early.

Meanwhile, as Kristin explains, women experiencing Genitourinary Syndrome of Menopause – which leads to vaginal dryness and increased UTI risk – may be offered several treatment options.

“This includes vaginal oestrogen, bladder retraining by specialised physiotherapists, or urogynaecology specialist input to determine if surgery is needed,” she says. By reducing UTI occurrence, we can minimise the chances of further kidney damage.

CKD arising from rarer conditions, such as an autoimmune disease, require more specific treatments that are monitored by specialists rather than a GP. In these instances, “significant advances in treatment are arriving, which we hope will radically improve patient outcomes,” assures Richard.

Words: Chantelle Pattemore