Women Lag Men in Receipt of Kidney Transplants, Dialysis

By Lisa Rapaport

November 05, 2019

(Reuters Health) - More men than women get kidney transplants and dialysis even though more women need these treatments for chronic kidney disease, a European study suggests.

Researchers examined five decades of data on the prevalence of chronic kidney disease and receipt of kidney replacement therapies like dialysis and transplants in nine European countries. Throughout the study period, women consistently lagged behind men in receipt of kidney replacement therapies - with about 60% of men and 40% of women who needed the treatments receiving them.

"These findings neither prove nor disprove the existence of gender disparity, but these results nevertheless might sensitize patients and their caretakers to potential sex differences, especially when it comes to initiating kidney replacement therapy," said Dr. Manfred Hecking, senior author of the study and associate professor of internal medicine at the Medical University of Vienna.

That's because the best time to consider dialysis or a transplant may vary from one patient to the next, and it's unclear from the study results how much the disparities might have been influenced by biology, access to care, or other factors, Hecking and colleagues write in the Clinical Journal of the American Society of Nephrology, online October 24.

"The best timing of kidney replacement therapy initiation is matter of debate," Hecking said by email.

Clear reasons for kidney replacement therapy include severe fluid overload that can lead to congestion in the lungs as well as high potassium levels that can cause heart rhythm abnormalities, Hecking said.

"Kidney replacement therapy helps normalize these problems, and people who need kidney replacement therapy but don't receive it might die."

It's not clear if women might have slower progression of kidney disease than men, making it possible for them to go longer before needing kidney replacement therapy, Hecking said.

But without needed dialysis, it's also possible that women have a higher risk of dying from kidney problems than men because women tend to live longer and have lower risk of dying from something else, Hecking added.

To examine sex differences in kidney replacement therapy over time, Hecking and colleagues analyzed data reported to the European Renal Association-European Dialysis and Transplant Association Registry from 1965 to 2015.

The study included information on 230,378 patients, and 39% were women.

The gender gap in receipt of kidney replacement therapy widened with age.

However, the gap remained consistent over time even as the main reasons for dialysis and transplants shifted to include more people with kidney failure resulting from diabetes.

The study wasn't designed to prove whether or how sex might impact receipt of kidney transplants or dialysis.

Still, the results suggest that patients should educate themselves about their treatment options when they have chronic kidney disease, said Dr. Catherine Clase of St. Joseph's Hamilton Healthcare and McMaster University in Ontario, Canada.

"Women with low kidney function should receive education on their options and, supported by their social structures and their health care team, should feel free to make the decision for themselves about which management options they prefer," said Clase, co-author of an editorial accompanying the study.

"In this regard, many people, both women and men, would prefer transplantation, but a big problem here is the relative scarcity of live donors," Clase said by email.

"People with good kidney function, who are close to someone with kidney failure who is eligible for a kidney transplant, should strongly consider being assessed as potential donors," Clase added. "All people should advocate for health policy that reimburses costs to donors and prioritizes a former donor who now has kidney failure to receive a transplant themselves."

SOURCE: https://bit.ly/2qexKAo and https://bit.ly/2po1dYU Clin J Am Soc Nephrol 2019.

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