Female Survival Advantage Fades in advanced Kidney Disease, New Study Finds
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A new study challenges the long-held belief that women consistently outlive men, revealing that women with stage 5 chronic kidney disease (CKD) face a higher risk of mortality and reduced access to life-saving kidney transplants compared to their male counterparts, particularly those over the age of 55.
For decades, research has demonstrated a female longevity advantage, with women typically living around 5.8 years longer than men. This trend extends across the animal kingdom, with females in approximately 72% of 528 mammal species exhibiting a roughly 13% longer lifespan. Though, this new investigation, published online November 17, 2025, in JAMA Internal Medicine, suggests this advantage disappears – and even reverses – in the context of severe kidney disease.
Unveiling Sex-Based Disparities in CKD
Prior research on chronic kidney disease and mortality frequently enough relied on data from patients referred to nephrology specialists, representing those with less advanced illness. This created a potential bias and limited the ability to generalize findings to individuals with stage 5 CKD, the most severe form of the disease. “To our knowledge, no population-based study has examined sex differences in mortality and treatment among individuals with incident stage 5 CKD,” explained a study investigator from the cumming School of Medicine.
To address this critical gap, researchers in Alberta, Canada, conducted a retrospective analysis of 7,506 adults diagnosed with stage 5 CKD. Stage 5 CKD was defined as a sustained estimated glomerular filtration rate (eGFR) below 15 mL/min/1.73 m2 for more than three months. The study meticulously tracked outcomes, including all-cause mortality and access to kidney replacement therapy (KRT), such as dialysis or transplantation.
A Reversal of Fortune: Mortality rates Shift
The analysis revealed a stark contrast in mortality rates based on sex and age. While women generally reach stage 5 CKD at an older age – a median of 74 years compared to 70 years for men – they experience increased excess mortality, especially at younger ages.Specifically, standardized mortality ratios (SMRs) were considerably higher for women aged 20 to 44 (47.5) compared to men in the same age group (12.0).This disparity lessened with age, becoming comparable in individuals 85 and older.
At five years post-diagnosis, female patients faced a 58.9% risk of all-cause mortality, compared to 51.9% for males. Moreover, 39.9% of women died while waiting for KRT, versus 28.3% of men.Perhaps most concerning,only 8.5% of female patients received a kidney transplant, significantly lower than the 14.5% rate observed in men.
Age-Specific trends and Future Research
Further analysis highlighted that increased mortality was observed in females under 55 years of age, while risks were similar between sexes in older age groups. Adjusted analyses indicated increased all-cause mortality in females under 45, increased death without kidney replacement therapy in those aged 65-74, and lower dialysis hazards in females 55 and older.
These findings underscore the urgent need for deeper investigation into the complex interplay of biological, structural, and societal factors that contribute to these sex-based differences in treatment and survival. “These findings highlight the need for further research into the biological,structural,and societal factors influencing sex differences in treatment decisions and survival,” the investigators concluded. .
This research serves as a critical reminder that generalizations about longevity based on population-level data may not apply to individuals battling serious illnesses like stage 5 CKD. A more nuanced understanding of these disparities is essential to ensure equitable access to care and improve outcomes for all patients.
