GENDER EQUITY FOR RENAL REPLACEMENT THERAPIES IN INDIA

Introduction:

There is a global gender discrepancy in the prevalence of chronic kidney disease (CKD) in the general population (higher in women) and access to renal replacement therapies (higher in men). There is sparse data on gender based access to renal replacement therapies in India where hemodialysis (HD) forms the mainstay of treatment. This study analysed the gender based access to renal replacement therapies from patients undergoing hemodialysis at Apex Kidney Care (AKC), a national dialysis service provider.

Methods:

A total of 36415 patients who were registered to receive maintenance hemodialysis across AKC centers in the country between August 15, 2008, and December 31, 2023 were studied. The gender distribution of these patients, gender specific long term survival rates on hemodialysis, hemodialysis outcomes, kidney transplant rates and the gender distribution of kidney donors was studied.

Results:

Out of the original 36415 patients, 19974 patients survived beyond the first 90 days after hemodialysis initiation and were included in this analysis. There were 6579 women (32.9%) and 13395 men (67.1%). The median survival for men at 5 years was 62.40% (CI 61.14-63.64%) and for women was 61.13% (CI 59.33-62.87%) (p=0.0323). A subset of patients discontinued hemodialysis (n=686, 1.88%) after initiation. A larger proportion of these were women (1.93%) in comparison to men (1.86%) (p=ns). Only 658 patients in this dataset (3.3%) underwent a kidney transplant. Donor details were available in 613 patients. The majority of all transplants were with living related donors (71.78%), some were deceased donors (22.84%) and the rest (5.38%) were other donors. The proportion of males with CKD who underwent a transplant (71.61%) was higher than females (28.39%) (p<0.014). In living donor transplant recipients 339 were male (77.05%) in comparison to 101 female recipients (22.95%, p<0.05). In deceased donor transplant recipients 77 were male (55%) in comparison to 63 female recipients (45%, p<0.05). Of all other donor transplant recipients 23 were male (70%) in comparison to 10 female recipients (30%, p<0.05). There was a clear gender inequality in living kidney donors where 120 were male donors (27.27%) and 320 were female donors (72.73%) (p<0.005). A male CKD patient had an available related donor in 77.22% in comparison to 58.04% for a female CKD patient (p<0.005). A male CKD had a female donor in 77% cases whereas a female CKD had a male donor in only 41.59% cases (p<0.001). Mothers formed the largest donor pool 39.1% (36.58% for male patients, and 41.6% for female patients). Spouses formed 25.1% of the donor pool (30.38% for male patients and 19.8% for female patients). Fathers formed 14.62% of the donor pool (15.34% for male patients, and 13.9% for female patients).

Conclusions:

Globally, there is a movement to become increasingly inclusive and pluralistic, with intolerance to discrimination of any kind. However, gender inequality persists in kidney disease treatment in India. Survival on hemodialysis in India is worse for women than for men. Similarly, transplant rates in women in India are lower than in men. More women than men donate their kidneys, but more men than women receive a kidney for transplantation. The reason why a woman’s survival on dialysis is inferior to a man could be because of social challenges in access to renal replacement therapy or for biological reasons.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.