Purpose: Elderly women with ESRD are significantly less likely than men of the same age and co-morbidities to be referred for kidney transplantation (KT), despite comparable outcomes. The goal of this study was to elucidate possible mechanisms for this disparity.

Methods: We surveyed 97 prevalent dialysis patients (45 male and 52 female) age 65 and older between January 2009-August 2010. We asked questions to assess patient’s perceptions of health, views on transplantation, and discussions with friends, family and healthcare staff about KT.

Results: Women were less likely to have an encouraging discussion with a spouse than their male counterparts (8.6% versus 44.0%; p<0.001) but not more likely to experience this with a family member other than a spouse (48.9% versus 52.0%; p=0.8). Women were less likely to have an encouraging discussion with a nephrologist than men (40.0% versus 64.0%; p=0.067). Females rated their ability to mentally tolerate a KT lower than males (51.7% versus 75.0% rated their ability as very well or well; p=0.082). Women were not more likely than men to believe that they were too weak to undergo KT (11.8% versus 13.0%; p= 0.9) but they were more likely to believe that a KT would not help them (20.6% versus 0.0%; p=0.023).

Conclusions: Our findings suggest that older women fail to discuss KT or face discouragement or indifference when the subject is discussed with their spouses. Although this could be influenced by wives outliving their husbands, lack of partner support could be driving this trend. Moreover, there is no difference in discussion with family members other than spouses underscoring spousal support as key. Nephrologists, more than any healthcare provider, were more encouraging to older men than women pointing to a possible healthcare provider bias. Elderly women had concerns about mentally tolerating KT and tended to doubt its benefit.

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