Access to treatment in chronic kidney disease, dialysis and transplantation. Is there gender equality?

Abstract

Sex and gender are often used as synonyms. However, while sex describes only a biological state, gender is a dynamic concept that takes into account psychosocial and cultural aspects of human existence that can change according to place and time. Inequality in medicine has been described in several areas. Among them, gender inequality has been disregarded for many years and is now a matter of concern. Chronic kidney disease (CKD) is a growing epidemic worldwide, affecting approximately 10% of the population. Although both men and women are affected, gender equality, especially in access to different treatments, is a matter of concern. We decided to investigate gender equality in patients with CKD. To this end, we conducted a literature narrative review to determine whether gender inequalities were found in CKD patients in general and in access to different treatment modalities in particular. A non-language restricted search was performed until November 30th 2022 in PubMed, SciELO, Trip Database, Google Scholar, MEDES y MEDLINE. We also investigated the situation in this regard in our country. We found that CKD is more prevalent in women than men, nevertheless this prevalence decreases along the CKD stages to the point that more men reach end stage kidney disease (ESKD) and dialysis. Access to transplant (ATT) is higher in men than in women although posttransplant survival shows no gender differences. Finally, most series have shown that women are more frequently Kidney transplantation (KT) living donors than men. Results in our country are similar to the published literature with the exception of a higher proportion of men as KT living donors. As in other areas, gender inequality in Nephrology has been largely overlooked. In this review we have highlighted gender differences in CKD patients. Gender inequality in Nephrology exists and needs to be looked upon in order to reach a personalized clinical approach.

Gender disparity in maintenance hemodialysis units in South India: a cross-sectional observational study

“…This sex discrepancy persists across various organ waitlists. In Argentina, as of 1 January 2023, only 18% (5,407 individuals) of dialysis patients aged 18 years and above were on the WL, 45.4% (2,456) were women, and 54.6% (2,951) were men ( 29 , 30 ). Numerous studies indicate that women with End-Stage Kidney Disease (ESKD) have 10% to 20% reduced access to kidney transplants compared to men, even after accounting for demographic and clinical traits ( 31 – 33 ).…”

Gender disparities in kidney replacement therapies and transplantation in Colombia

“…However, this prevalence diminishes across the CKD stages, culminating in a notable increase in men reaching the end stage kidney disease (ESKD) requiring dialysis. Notably, access to transplant (ATT) is more prevalent among men than women, although post-transplant survival rates exhibit no discernible gender differences [ 14 ].…”