Ackd

Advances in Chronic Kidney Disease

Vol 20, No 5, September 2013

GUEST EDITORIAL

Who Impels Nephrology: Women

bout 1 year ago, Jerry Yee asked me if I would coguest edit an issue of Advances in Chronic Kidney Disease about women and kidney disease with Sharon Silberger. I agreed, and we formulated a table of contents and began to invite authors. Unfortunately, Sharon died September 6, 2012 after a long battle with chondrosarcoma. This issue is dedicated to her. Amy Williams and Connie Davis graciously agreed to step in as co-guest editors. This is not the rst issue to focus on women and kidney disease. The January 1998 issue of Advances in Renal Replacement Therapy, the predecessor to Advances in Chronic Kidney Disease, focused on pregnancy in ESRD and was edited by Susan Hou. The January 2003 issue was titled Gender Issues in End-Stage Renal Disease and was edited by Wendy Weinstock Brown and Kathryn Sandberg. It included articles on gender and progression of kidney disease, sex and the renin-angiotensinaldosterone system, cystic disease in women, the effect of pregnancy on underlying kidney disease, pregnancy in kidney transplant recipients, sexual dysfunction in men and women with kidney disease, and psychosocial issues in women with kidney disease. The October 2004 issue of Advances in Chronic Kidney Disease was titled Hormones and Chronic Kidney Disease and was edited by Catherine Stehman-Breen and Kirsten Johansen. Although not focused only on women, it did include articles on the hypothalamic-pituitary axis in men and women with CKD, the pharmacokinetics of estrogen and progesterone in CKD, and outcomes associated with hypogonadism in women with CKD. The April 2007 issue of Advances in Chronic Kidney Disease revisited pregnancy and CKD and was edited by Jean Holley, and this issue was recently revisited by Belinda Jim and Susan Hou in the May 2013 issue of this journal. This issue is titled Women and Renal Disease. Appropriately, this issue begins with a moving tribute to Dr. Sharon Silbiger in a special editorial written by Victor Schuster, her department chairman and nephrology

colleague at Albert Einstein. Her commitment to health-care disparities in kidney disease and mentoring young physicians and students is inspiring. We feel she would be thrilled to be honored in this issue, which focuses on 1 of her passions, kidney disease in women. The rst article is Women: Medicine, Their Kidneys and Nephrology by Garabed Eknoyan. He traces the history of women as compassionate caregivers, important progress and contributions that women have made as medicine evolved into a profession, and the important role of women in nephrology. The next paper is Women and the Prevalence and Progression of Renal Disease by Joel Neugarten. This is an excellent discussion of the role of sex hormones and gender as important determinants of susceptibility to progressive kidney injury potentially leading to disparity in ESRD incidence rates. He also reviews the existing and conicting studies and the evidence behind the underlying effects of sex hormones on cellular biology as well as the effects of lifestyle and environmental exposures. The third article is Women and Hypertension by Phyllis August. The next is Women, Renal Disease, and Pregnancy by Vesna Garovic. This paper describes the management of kidney disease in pregnancy and the risks of that treatment on the mother and fetus (see Advances in Chronic Kidney Disease, May 2013). The fth article is Women and ESRD: Modalities, Survival, Unique considerations by Kelly Guglielmi. She describes the reproductive hormone disturbances that occur in women on dialysis and the tremendous inuence that has on sexual function and dysfunction, bone density, and cardiovascular disease. Importantly, she notes that depression is common in women on dialysis but is
Published by Elsevier Inc. on behalf of the National Kidney Foundation, Inc. 1548-5595/$36.00 http://dx.doi.org/10.1053/j.ackd.2013.06.009

Advances in Chronic Kidney Disease, Vol 20, No 5 (September), 2013: pp 379-380

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under-recognized and undertreated. Nannette Wenger clearly outlines the most current recommendations for Prevention of Cardiovascular Disease in Women, giving practical approaches to care and prevention. Strategies for managing risk factors and enhancing cardiovascular health for our patients as well as ourselves are included. Stuart Sprague and Tammy Ho then expound on women and kidney bone disease. I saw Stuart at a social event recently, and he commented that he was amazed at the number of gender-based studies he had encountered while reviewing the literature. There are 2 articles on women and transplantation. In the rst paper, Deborah Adey discusses the recipient and allograft survivals in men and women and outlines the posttransplant complications, highlighting those that pose a higher or unique risk for women. She also notes the difference in patterns of kidney donation to men vs women. In the second, Michele Josephson addresses fertility, sexuality, pregnancy, and contraception in female transplant

recipients. Finally, Amanda Chi and Sarah Coleman Flury present Urology Patients in the Nephrology Practice and address urologic issues in men and women with kidney disease. It is obvious after re-reading the previous issues regarding women, kidney disease, pregnancy, and hormones that huge strides have been made and more are yet to come. Wendy W. Brown, MD, MPH Jesse Brown V A Medical Center Chicago, IL Connie L. Davis, MD Skagit Regional Health Mount Vernon, WA Amy W. Williams, MD Mayo Clinic Rochester Mayo Clinic Rochester, MN Guest Editors