Among adults with End Stage Renal Disease (ESRD), there is evidence that females are less likely to receive renal transplant compared to males and blacks are less likely to receive peritoneal dialysis (PD) or preemptive transplantation (pTx). However, previous studies in pediatric ESRD have not examined gender differences in access to PD or pTx compared to hemodialysis (HD) at initiation of renal replacement therapy (RRT).

Method: We examined patients <21 yrs in USRDS (01/01/05-09/30/09). Generalized logit models were used to calculate odds ratios (OR) and 95% confidence intervals (CI) of RRT choice by gender. We adjusted for differences in age, race/ethnicity, SES (based on zip code and insurance status), etiology of ESRD, OPO region and access to pre-ESRD nephrology care.

Results: In crude analyses, among 7,010 patients initiating RRT, (42.7% females, 45.6% white; 30.4% Hispanic, and 24.0% black); females (vs. males) were less likely to have pTx (OR=0.72; 95% CI:0.62-0.84) compared to HD; however, there were no gender disparity in the likelihood of PD (OR=1.01;95% CI: 0.91-1.13) vs. HD. Within each race/ethnicity, males were more likely to receive pTx than females.

Patients with cystic/hereditary etiology of ESRD, secondary GN and FSGS were more likely to have PD; patients with GN, FSGS and lupus nephritis were less likely to have pTx compared to other ESRD etiologies. In adjusted analyses, females and males had the same odds of pTx (OR=1.04, 95% CI:0.88-1.23). This was primarily explained by gender differences in the etiology of ESRD, with females less likely to have congenital/hereditary causes (22.9% vs. 36.3%) and more likely to have lupus (13.1% vs. 2.2%) compared to males (p value for gender and ESRD etiology interaction <0.001).

Conclusion: Gender disparities exist in pediatric ESRD patients in the choice of RRT, however, unlike in adults these disparities were primarily driven by differences in the etiology of ESRD.

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