Kidney disease and venous thromboembolism: Does being woman make the difference?

- Gender affects the incidence, prevalence, and progression of many renal diseases.
- Sex differences are evident in the etiology of kidney disease.
- CKD increases by 25%-30% the risk for thrombotic manifestations.
- Sex and gender stratified analysis to assess the VTE incidence in patients with kidney disease are scarce.
- Sex stratified analysis on coagulation system in CKD have never been performed.

The risk of venous thromboembolism (VTE) is increased across the spectrum of chronic kidney disease (CKD), from mild to more advanced CKD, and typically characterizes nephrotic syndrome (NS). VTE risk in patients with kidney disease may be due to underlying hemostatic abnormalities, including activation of pro-thrombotic factors, inhibition of endogenous anticoagulation systems, enhanced platelet activation and aggregation, and decreased fibrinolytic activity. The mechanisms involved differ depending on the cause of the kidney impairment (i.e. presence of NS or CKD stage). Sex and gender differences, as well as, environmental factors or comorbidities may play a modulating role; however, specific sex and gender data on this topic are still rare. The aim of the present review is to discuss the VTE risk associated with impairment of kidney function, the potential mechanism accounting for it and the impact of sex differences in this clinical setting.