Dr Rosnawati Binti Yahya

Spokesperson: Dr Rosnawati Binti Yahya, Consultant Nephrologist and Kidney Transplantation Physician, Sunway Medical Centre (SMC)

Chronic Kidney Disease (CKD) is often described as a “quiet disease”, one that progresses silently until damage is advanced. The worldwide prevalence of CKD shows that women develop the condition at a rate of 11.8% while men develop it at a rate of 10.4%.[1] The Malaysian data shows the same distribution pattern because women have a 14% prevalence rate slightly exceeding men at 12%.[2]

The gender gap is not always obvious in day-to-day practice. “What we consistently see is that the majority of CKD is still driven by metabolic conditions like diabetes and hypertension, and these affect men and women in fairly similar numbers,”explains Dr Rosnawati.

Diabetes and hypertension are biggest culprits

Up to 86% of CKD cases in kidney centres are caused by metabolic disease. The Malaysian Dialysis and Transplant 2023 Registry data shows that diabetes and hypertension are the main causes of kidney failure, accounting for 56% and 30% of cases respectively. [3] The two conditions operate in the background to gradually damage the kidneys through multiple years without showing any apparent signs.

What remains concerning is that so many people find out about their kidney condition too late. Many only discover they have CKD when kidney function has already declined significantly, sometimes just when dialysis becomes an immediate necessity.“This is why screening is important. The first three stages of CKD are usually asymptomatic. If you wait for symptoms, you are already late,” Dr Rosnawati emphasises.

Gender factor in autoimmune disease

While kidney disease can affect anyone, women are more like to experience autoimmune-related kidney conditions. One of the most common is lupus nephritis, a complication of systemic lupus erythematosus (SLE). Although rarer in men, the symptoms and kidney damage are often more severe when it occurs.

“SLE mainly affects women, with female-to-male ratios as high as 9 to 1.[4] When it involves the kidneys, women still make up most cases,” says Dr Rosnawati.

Oversight on symptoms

Dr Rosnawati shares one of the reasons CKD remains underdiagnosed, particularly among women, is that its symptoms are easily dismissed. Symptoms are frequently mistaken for everyday life or hormonal changes, such as persistent tiredness or fatigue that is usually blamed on being too busy with household, work or childcare; lethargy that is often dismissed as anaemia, menstrual symptoms or tiredness; frequent night-time urination which some women attribute it to weakened pelvic floor muscles after childbirth; and swelling in the legs, ankles or face, which may be dismissed as fluid retention.

“Women often normalize these symptoms. They assume it is stress, ageing, or hormones instead of kidney disease,” she says. However, she shares some red flag symptoms that could indicate CKD such as changes in urination (frequency, color, or foamy urine), loss of appetite or nausea or high blood pressure that is hard to control.

Blood test results can be misleading, especially for women. Creatinine levels, a primary indicator of kidney function, are directly affected by muscle mass. She urges women not to rely on numbers alone but to ask their doctor what those numbers really mean for them.

“Since women generally have less muscle than men, a ‘normal’ creatinine level might still mask early kidney issues. A reading of 90 may be fine for a large man, but in a petite woman, it could signal reduced kidney reserve,” explains Dr Rosnawati.

Female life stages that leave long-term imprint on kidney health

Pregnancy and menopause are two life events that can increase a woman’s risk of future kidney problems. Complications like preeclampsia and gestational diabetes indicate persistent vascular or metabolic issues, raising the risk of hypertension, proteinuria, and CKD two to four times. After menopause, lower oestrogen further reduces kidneys and blood vessels protection, potentially accelerating disease progression.

“Additionally, polycystic ovary syndrome (PCOS) has emerged as a significant but under-recognised risk factor. It is closely linked to insulin resistance, obesity, and metabolic syndrome. It can also lead to diabetes and high blood pressure earlier in life, both major causes of kidney damage over time,” Dr Rosnawati adds.

Dr Rosnawati stresses the importance of getting blood pressure and blood sugar tests every year. “Just because blood pressure or blood sugar normalises at one stage of life does not mean the risk disappears. Women need long-term follow-up, even if they feel well,” she says.

Early warnings and simple tests

For women, especially those with diabetes, high blood pressure, obesity, autoimmune disease, or a history of pregnancy complications, early screening for kidney disease is not optional, it is essential. Just three simple tests can catch trouble early:

• A blood test for kidney function
• A urine test for protein (preferably a urine albumin-to-creatinine ratio)
• A blood pressure check

“Protein in the urine is one of the earliest signs of kidney damage, yet many dipstick tests miss it. Early detection changes everything as there are so many treatment options available. With the right treatment, kidney decline can also be slowed dramatically,” says Dr Rosnawati.

“Our goal is preservation. If we can reduce the kidney decline from 10% a year to just 2%, many patients may never need dialysis,” she explains.

CKD develops quietly, often going unnoticed until it is advanced. Therefore, recognising the signs early and taking prompt action is important. For women who look after others, remember that your health is the foundation of the care you provide. Hence, prioritising your own health is essential, not selfish.

“Even if you feel fine, get checked. Do not wait for symptoms. If your blood tests are ‘normal’ but something still feels off, ask your doctor about your kidneys,” urges Dr Rosnawati.

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References:

[1] https://www.sciencedirect.com/science/article/pii/S2157171621000666

[2] https://nkf.org.my/wp-content/uploads/2018/09/nkf-may13_1.pdf

[3]https://msn.org.my/nrr/wp-content/uploads/2024/12/FinalChapter-2_HooiChoo-Najdah-Jasmine-v2_ong28-Oct-2024_v5.pdf

[4]https://www.openaccessjournals.com/articles/epidemiology-of-systemic-lupus-erythematosus-prevalence-incidence-and-risk-factors.pdf

Consultant Nephrologist and Kidney Transplantation Physician at Sunway Medical Centre (SMC), Sunway City, Dr Rosnawati Yahya said many patients only discover their condition when kidney function has already declined substantially.

“The first three stages of CKD are usually asymptomatic. If you wait for symptoms, you are already late,” she said in a statement released in conjunction with World Kidney Day, observed on March 12.

She added that the majority of CKD cases are still driven by metabolic conditions like diabetes and hypertension, which affect men and women in fairly similar numbers.

Data from the Malaysian Dialysis and Transplant 2023 Registry shows diabetes accounts for 56 per cent of kidney failure cases, while hypertension contributes 30 per cent.

According to Dr Rosnawati, early symptoms of CKD are often overlooked because they resemble common conditions such as fatigue, hormonal changes or anaemia.

Among the signs are persistent tiredness, lethargy, frequent night-time urination, and swelling in the legs, ankles or face.

“Women often normalise these symptoms, assuming it is stress, ageing, or hormonal changes, instead of kidney disease,” she added.

She also cautioned that blood test readings may sometimes mask early kidney problems in women.

“Since women generally have less muscle than men, a ‘normal’ creatinine level might still mask early kidney issues. A reading of 90 may be fine for a large man, but in a petite woman it could signal reduced kidney reserve,” she explained.

Dr Rosnawati said systemic lupus erythematosus (SLE) mainly affects women, with female-to-male ratios as high as 9:1, and kidney involvement remains more common among female patients.

She also pointed out that certain life stages, such as pregnancy and menopause, may increase long-term kidney risks.

Complications such as preeclampsia and gestational diabetes may indicate underlying vascular or metabolic problems, increasing the risk of hypertension, proteinuria and CKD two to four times later in life.

“Additionally, polycystic ovary syndrome (PCOS) has emerged as a significant but under-recognised risk factor. It is closely linked to insulin resistance, obesity and metabolic syndrome. It can also lead to diabetes and high blood pressure earlier in life, both major causes of kidney damage over time,” she said.

Dr Rosnawati advised women, especially those with diabetes, hypertension, obesity, autoimmune diseases or pregnancy complications, to undergo regular screening.

She said three simple tests can help detect kidney disease early — a blood test for kidney function, a urine test for protein and a blood pressure check.

“Protein in the urine is one of the earliest signs of kidney damage. Early detection changes everything as there are many treatment options available. Our goal is preservation. If we can reduce kidney decline from 10 per cent a year to just two per cent, many patients may never need dialysis,” she said.

Source: Bernama