GENDER DISPARITY ACROSS SPECTRUM OF KIDNEY CARE- A HARSH REALITY

Introduction:

Gender differences in diseases are common across medical fields, but sex-based disparities in kidney diseases are underexplored, especially in India. This study examines gender disparities in kidney disease patients. In India, with a population of 1.2 billion, about 8 million develop chronic kidney disease (CKD) annually, with 200,000 progressing to end-stage kidney disease (ESKD) and requiring maintenance hemodialysis (MHD). The Government of India, through the Pradhan Mantri National Dialysis Program and the Hub and Spoke Model, has developed extensive kidney care networks for MHD. This study analyses gender disparities across the spectrum of kidney disorders in patients attending outpatient services, hospitalized patients, those undergoing interventions, and those on kidney replacement therapy (KRT) using data from a tertiary care centre and its 21 associated spoke canters.

Methods:

 This cross-sectional study collected data from the Hub hospital and its 21 spoke canters. Sources included outpatient and inpatient records, biopsy records, vascular access data, and KRT records, including HD, PD, and transplant. Statistical significance was set at p < 0.05.

Results:

Outpatients: Fewer females accessed outpatient renal care services, likely due to social factors.

Hospitalized Patients: Fewer females were hospitalized for kidney disorder treatment, highlighting limited access to care for women.

Hemodialysis (HD): The proportion of females on dialysis was 29.1%, markedly lower than males. Although CKD prevalence is higher in females (Hill et al.), fewer women receive MHD, as noted by Shankar et al. (27.3%) and Sahay et al. (24.2%). Social barriers likely limit dialysis access for women. Although female MHD patient numbers have slightly increased, the gender imbalance persists.

Vascular Access: AVF access was present in 85.6% of males and 78.2% of females. Port et al., using DOPPS data, similarly found males were more likely to have AVF. Despite no significant difference in vein and artery anatomy between genders (Caplin et al.), studies report poorer AVF outcomes in women (Lee et al.). This may prompt surgeons and nephrologists to favour CVC over AVF for female patients. Social factors may also reduce AVF access for women, although Shankar et al. found no such disparity in their study.

Transplant: Most living kidney transplant recipients are male, while female donors dominate, consistent with global and Indian studies (Malattiri et al., Sahay et al., Melk et al., Kim et al., Liu et al., Garcia et al.). Male deceased donors are more common, mainly due to traffic accidents involving male drivers. Salas et al. found females less likely to be registered for transplants, in line with Wolfe et al.’s finding that females have lower odds of being waitlisted.

Conclusions:

This study goes beyond focusing solely on KRT to reveal gender disparities across all aspects of kidney disease care—from outpatient services to hospitalizations, interventions, and KRT. The disparities in hemodialysis and transplantation are particularly striking, underscoring the social challenges women with kidney disease face. This study calls for immediate, effective action to address these disparities. By implementing targeted interventions, improving access, and promoting gender-sensitive practices, we can create a more equitable healthcare environment that better serves all genders

I have no potential conflict of interest to disclose.

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