Patrick Ahearn1, Kirsten L Johansen2,3, Jane C Tan4, Charles E McCulloch5, Barbara A Grimes5, Elaine Ku5,6,7. 1. Division of Nephrology, Stanford University, Palo Alto, California pahearn@stanford.edu. 2. Division of Nephrology, Hennepin County Medical Center, Minneapolis, Minnesota. 3. Division of Nephrology, University of Minnesota, Minneapolis, Minnesota. 4. Division of Nephrology, Stanford University, Palo Alto, California. 5. Department of Epidemiology and Biostatistics, University of California, San Francisco, California. 6. Division of Nephrology, University of California, San Francisco, California. 7. Division of Pediatric Nephrology, University of California, San Francisco, California.
Abstract
BACKGROUND AND OBJECTIVES: Women with kidney failure have lower access to kidney transplantation compared with men, but the magnitude of this disparity may not be uniform across all kidney diseases. We hypothesized that the attributed cause of kidney failure may modify the magnitude of the disparities in transplant access by sex. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We performed a retrospective cohort study of adults who developed kidney failure between 2005 and 2017 according to the United States Renal Data System. We used adjusted Cox models to examine the association between sex and either access to waitlist registration or deceased-donor kidney transplantation, and tested for interaction between sex and the attributed cause of kidney failure using adjusted models. RESULTS: Among a total of 1,478,037 patients, 271,111 were registered on the waitlist and 89,574 underwent deceased-donor transplantation. The rate of waitlisting was 6.5 per 100 person-years in women and 8.3 per 100 person-years for men. In adjusted analysis, women had lower access to the waitlist (hazard ratio, 0.89; 95% confidence interval, 0.89 to 0.90) and to deceased-donor transplantation after waitlisting (hazard ratio, 0.96; 95% confidence interval, 0.94 to 0.98). However, there was an interaction between sex and attributed cause of kidney disease in adjusted models (P<0.001). Women with kidney failure due to type 2 diabetes had 27% lower access to the kidney transplant waitlist (hazard ratio, 0.73; 95% confidence interval, 0.72 to 0.74) and 11% lower access to deceased-donor transplantation after waitlisting compared with men (hazard ratio, 0.89; 95% confidence interval, 0.86 to 0.92). In contrast, sex disparities in access to either the waitlist or transplantation were not observed in kidney failure secondary to cystic disease. CONCLUSIONS: The disparity in transplant access by sex is not consistent across all causes of kidney failure. Lower deceased-donor transplantation rates in women compared with men are especially notable among patients with kidney failure attributed to diabetes.
BACKGROUND AND OBJECTIVES: Women with kidney failure have lower access to kidney transplantation compared with men, but the magnitude of this disparity may not be uniform across all kidney diseases. We hypothesized that the attributed cause of kidney failure may modify the magnitude of the disparities in transplant access by sex. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We performed a retrospective cohort study of adults who developed kidney failure between 2005 and 2017 according to the United States Renal Data System. We used adjusted Cox models to examine the association between sex and either access to waitlist registration or deceased-donor kidney transplantation, and tested for interaction between sex and the attributed cause of kidney failure using adjusted models. RESULTS: Among a total of 1,478,037 patients, 271,111 were registered on the waitlist and 89,574 underwent deceased-donor transplantation. The rate of waitlisting was 6.5 per 100 person-years in women and 8.3 per 100 person-years for men. In adjusted analysis, women had lower access to the waitlist (hazard ratio, 0.89; 95% confidence interval, 0.89 to 0.90) and to deceased-donor transplantation after waitlisting (hazard ratio, 0.96; 95% confidence interval, 0.94 to 0.98). However, there was an interaction between sex and attributed cause of kidney disease in adjusted models (P<0.001). Women with kidney failure due to type 2 diabetes had 27% lower access to the kidney transplant waitlist (hazard ratio, 0.73; 95% confidence interval, 0.72 to 0.74) and 11% lower access to deceased-donor transplantation after waitlisting compared with men (hazard ratio, 0.89; 95% confidence interval, 0.86 to 0.92). In contrast, sex disparities in access to either the waitlist or transplantation were not observed in kidney failure secondary to cystic disease. CONCLUSIONS: The disparity in transplant access by sex is not consistent across all causes of kidney failure. Lower deceased-donor transplantation rates in women compared with men are especially notable among patients with kidney failure attributed to diabetes.
Authors: R A Wolfe; V B Ashby; E L Milford; W E Bloembergen; L Y Agodoa; P J Held; F K Port Journal: Am J Kidney Dis Date: 2000-11 Impact factor: 8.860
Authors: Dorry L Segev; Christopher E Simpkins; Richard E Thompson; Jayme E Locke; Daniel S Warren; Robert A Montgomery Journal: J Am Soc Nephrol Date: 2007-12-19 Impact factor: 10.121
Authors: R W Evans; D L Manninen; L P Garrison; L G Hart; C R Blagg; R A Gutman; A R Hull; E G Lowrie Journal: N Engl J Med Date: 1985-02-28 Impact factor: 91.245
Authors: Christine Park; Mandisa-Maia Jones; Samantha Kaplan; Felicitas L Koller; Julius M Wilder; L Ebony Boulware; Lisa M McElroy Journal: Int J Equity Health Date: 2022-02-12
Authors: Rachel B Cutting; Angela C Webster; Nicholas B Cross; Heather Dunckley; Ben Beaglehole; Ian Dittmer; John Irvine; Curtis Walker; Merryn Jones; Melanie Wyld; Patrick J Kelly; Kate Wyburn; Nicole L De La Mata Journal: PLoS One Date: 2022-08-25 Impact factor: 3.752