Trends in Sex Disparities in Access to Kidney Transplantation: A Nationwide US Cohort Study
Abstract
RATIONALE & OBJECTIVE
Women with kidney failure have reduced access to kidney transplantation compared to men. We examined trends in sex inequities in access to transplantation over time.
STUDY DESIGN
Retrospective cohort study.
SETTING & PARTICIPANTS
2.3 million adults identified within the United States Renal Data System, aged 18-79 years, who initiated kidney replacement therapy (KRT) between 1997 and 2020.
EXPOSURES
Era of KRT (1997-2000, 2001-2004, 2005-2008, 2009-2012, 2013-2016, or 2017-2020), Sex (male or female).
OUTCOMES
Placement onto the kidney transplant waitlist or LDKT among all individuals initiating KRT, and DDKT among patients on the waitlist.
ANALYTICAL APPROACH
Multivariable cause-specific hazard models to analyze the association between sex and placement onto the waitlist, LDKT, and DDKT, by era, overall, and by categories of age, race, and cause of kidney failure.
RESULTS
Sex inequities in waitlisting became less pronounced over time. During 1997-2000 the adjusted hazard ratio comparing men to women was 0.81; 95%CI: [0.79-0.83]) and by 2017-2020, narrowed to 0.86 [0.85-0.87]). For the outcome of LDKT, during 1997-2000, the adjusted hazard ratio comparing men to women was (0.89 [0.85-0.93]) and by 2017-2020, widened to 0.79 [0.76-0.82]). For the outcome of DDKT, during 1997-2000, the adjusted hazard ratio comparing men to women was (0.92 [0.89-0.95]) and by 2017-2020, widened to (1.16 [1.14-1.19]). Sex inequities in waitlisting and LDKT were greatest in…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence.
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