Gender Disparities in Need for Dialysis, Access to the Renal Transplant Waitlist and Renal Transplant Survival
1Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
2Medical Sociology, Hannover Medical School, Hannover, Germany
3Pediatric Nephrology, Hannover Medical School, Hannover, Germany
4Institute of Transplantation Immunology, Hannover Medical School, Hannover, Germany.
Meeting: 2018 American Transplant Congress
Abstract number: A328
Keywords: Kidney
Session Information
Session Name: Poster Session A: Non-Organ Specific: Disparities to Outcome and Access to Healthcare
Session Type: Poster Session
Date: Saturday, June 2, 2018
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Hall 4EF
A patient with chronic kidney disease undergoes several transition phases, such as start of dialysis, the placement on the transplant waiting list and finally renal transplantation. Access to transplantation differs between women and men. Most of the available studies consider only one of the several transition phases that lead to transplantation. In particular we examined, whether gender differences are present in terms of chances of transitions from chronic kidney disease to dialysis, then for being placed on the waiting list for transplantation, proceeding from the waitlist to transplantation and finally transplant survival.
The basis of the analyses is a set of pseudonymised claims data of a local statutory health insurance, the AOK Niedersachsen (AOKN) covering the years 2005 to 2013 with about 2 Mill. insured aged 18 years and older. The statistical “chance” for changing from one state to another was examined by means of regression analyses using the Cox Proportional Hazards model. Effects are presented in terms of hazard ratios with 95% confidence intervals. The validity of the proportional hazards-assumption was examined by plotting Kaplan-Meier curves. All statistical analyses were performed with STATA 11MP.
In the Cox regression model adjusted for age and comorbidities women had a 16% lower risk of progressing to end stage renal disease (HR 0.84, 95 % CI 0.79-0.88), a 18% lower chance to get waitlisted (HR 0.70 – 0.96) and an identical chance to get transplanted if waitlisted (HR 0.96, 95 % CI 0.81-1.15) than man. When transplanted the risk of transplant failure was influenced strongly by the age group: In women aged 18-45 the risk of transplant failure or death was twice as high as in man (HR 2.08 95 % CI 1.04-4.14), whereas the risk in elderly women aged 65 and higher was half the risk of man (HR 0.47, 95 % CI 0.24-0.93).
Gender disparities occur at different steps in the history of a CKD patient. The cause for the disparities might be biological or socio-economic. Strategies to overcome the disparities are needed in both directions depending on the disease stage.
CITATION INFORMATION: Schmidt B., Epping J., Falk C., Geyer S., Melk A. Gender Disparities in Need for Dialysis, Access to the Renal Transplant Waitlist and Renal Transplant Survival Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Schmidt B, Epping J, Falk C, Geyer S, Melk A. Gender Disparities in Need for Dialysis, Access to the Renal Transplant Waitlist and Renal Transplant Survival [abstract]. https://atcmeetingabstracts.com/abstract/gender-disparities-in-need-for-dialysis-access-to-the-renal-transplant-waitlist-and-renal-transplant-survival/. Accessed May 16, 2025.« Back to 2018 American Transplant Congress