Sex disparities in dialysis initiation, access to waitlist, transplantation and transplant outcome in German patients with renal disease—A population based analysis

Abstract

Background Renal transplantation access and outcome differ between men and women, but no analysis has considered all transition phases and transplant outcome using the same data set. We analyzed sex disparities in all phases of patients’ clinical path (progression to dialysis, waitlisting, transplantation, graft failure/death). Methods In a population based approach using health insurance data (2005–2013) we examined patients’ risk of changing from one phase to another applying Cox Proportional Hazards model. Results After adjusting for age and comorbidities, women had a 16% lower risk of progression to ESRD (HR/95%-CI: 0.84/0.79–0.88). Access to the waitlist was lowered by 18% in women compared to men (HR/95%-CI: 0.82/0.70–0.96). An age stratified analysis did not reveal differences in any age group. Once waitlisted, the chance to receive a transplant was identical (HR/95%-CI: 0.96/0.81–1.15). The risk of transplant failure/death was identical for both sexes (HR/95%-CI: 0.99/0.73–1.35), but the effect was modified by age: in younger women (18–45 years) the risk was twice as high compared to men (HR/95%-CI: 2.08/1.04–4.14), whereas the risk in elderly women (> 65 years) was only half the risk of men (HR/95%-CI: 0.47/0.24–0.93). Conclusion Sex disparities occurred at different steps in the history of patients with renal disease and affected progression to dialysis, waitlisting and transplantation outcome in a population with equal access to medical treatment.

Sex Differences in Kidney Transplantation: Austria and the United States, 1978–2018

“…Our analysis follows a recently articulated request ( 16 ) to start focusing on non-North American cohorts in examining how sex and gender affect transplantation and compared them with the US. In accordance with previous data from the US ( 1 – 8 , 24 , 33 , 40 ), Canada ( 41 ), France ( 42 ), Australia ( 43 ) and Germany ( 44 ), in our analysis predominantly older women have lower access to kidney transplantation than men. Knowing the development in the US and Austria over the last four decades is informative, and this development renders it likely that gender disparity is the root cause of the observed sex differences in kidney transplantation.…”

Gender-Specific Differences in Self-Care, Treatment-Related Symptoms, and Quality of Life in Hemodialysis Patients

“…There are gender and sex differences that negatively affect women with KF from the initial diagnosis through access to a substitute renal treatment [ 13 , 14 ], including renal transplant [ 15 ]. Some studies have shown lower QoL among women in HD [ 16 ].…”

Kidney Function, Kidney Replacement Therapy, and Mortality in Men and Women

“…Furthermore, in the United States, it has been shown that women in the general population are less aware of their CKD, both in early and late stages, 30 that men are better prepared with arteriovenous fistulas at dialysis initiation, 31 and that women on dialysis have lower chances to enter wait-lists for kidney transplantation. 32 All of these reports indicate better CKD diagnosis and treatment for men.…”