Abstract: SA-PO175
Sex Disparity to Kidney Transplant Varies by Cause of ESRD
Session Information
- Diabetic Kidney Disease: Clinical - II
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Diabetic Kidney Disease
- 602 Diabetic Kidney Disease: Clinical
Authors
- Ahearn, Patrick, UCSF, San Francisco, California, United States
- Johansen, Kirsten L., UCSF, San Francisco, California, United States
- McCulloch, Charles E., UCSF, San Francisco, California, United States
- Grimes, Barbara A., UCSF, San Francisco, California, United States
- Ku, Elaine, UCSF, San Francisco, California, United States
Background
Women are significantly less likely to undergo transplantation than men. The possibility that transplant access differs by underlying cause of ESRD among men and women has not been thoroughly evaluated.
Methods
Using data from the US Renal Data System (USRDS), we performed a retrospective cohort study of adults who required their first renal replacement therapy between January 1, 1995 and June 30, 2016. In two approaches, considering either all patients with ESRD or only those with a waitlist date, we examined the association between sex and likelihood of transplant by cause of ESRD (including diabetes mellitus type 2 (DM2), hypertension, cystic/obstructive disease, and diabetes mellitus type 1) using adjusted Cox models.
Results
There were 266,616 kidney transplants among 2,228,769 adults with ESRD. In fully adjusted analyses, the likelihood of transplant for women was 0.82 (95% CI 0.82-0.83) times that of men in the full cohort and 0.91 (95% CI 0.90-0.92) times that of men considering only those registered on the waitlist. In both analyses, cause of ESRD modified the association between sex and access to transplantation (p<0.001), such that likelihood of transplant was markedly lower in women (vs. men) with ESRD due to DM2. In contrast, the sex disparity in transplant access was less profound in women with other causes of ESRD (figure).
Conclusion
Sex disparity in kidney transplant access varies substantially by cause of ESRD. Regardless of whether analyses included all patients with ESRD or only those registered on the waitlist, women (vs. men) with DM2 had the lowest access to kidney transplant compared to women (vs. men) with other attributed causes of kidney disease. This disparity is concerning, given that DM2 is the leading cause of ESRD in the US, and these patterns were observed even among those waitlisted for transplant.
Funding
- NIDDK Support