Gender Inequality In Access To Renal Replacement Therapy In Pediatric Population: Experience From A Single Center

Introduction: Gender inequality in access to dialysis facility and renal transplantation is extensively reviewed amongst adult patients. However, less is known about extent of gender inequality among pediatric CKD population. Materials and Methods: This was a retrospective data analysis of pediatric kidney transplants performed at single center from Gujarat from 2005 to 2019. Data was analyzed to look for gender inequality among donors and recipients. Further, children with ESRD on dialysis at center were observed for gender differences. We also reviewed gender difference among these ESRD patients for their process of transplantation. Results: During 2005 to 2019, 412 pediatric transplants were performed. Out of these, 329 (79.85%) were live renal transplants and 83 (20.14%) were deceased donor organ transplants. Remarkable gender difference was seen with boys (323, 78.4%) being majority of recipients versus girls (89, 21.6%). Also, among live donors, females have been major donors (237, 72%). However, among 83 cadaver donors, 53 (63.8%) were male. Currently, total 326 patients are on dialysis. Out of 326 ESRD patients on dialysis,207 (63%) are boys as compared to 119(37%) girls. Among these 326 patients 10 are under live related transplant work up (7 male, 3 female). Out of 326 patients, 34 are registered under state cadaver organ donor program, amongst them 22 (64%) are boys. Conclusion: Gender inequality in access to renal replacement therapy does exist. Girls have lower chances of receiving dialysis and transplantation than boys, but female constitute majority of living kidney donors. However, reasons for this gender difference for treatment choices is not very well studied, but sociocultural influences and socioeconomic factors are possible causes. Greater attention is necessary to improve the outcome of pediatric female patients with ESRD. References: 1. Gender Disparities in Access to Pediatric Renal Transplantation in Europe: Data From the ESPN/ERA-EDTA Registry J. Hogan, C. Couchoud, M. Bonthuis, J. W. Groothoff, K. J. Jager, F. Schaefer, and K. J. Van Stralen. American Journal of Transplantation 2016; 16: 2097–2105 2. Sex, Race, and Socioeconomic Disparities in Kidney Disease in Children Maria Lourdes Minnick, PhD, Sara Boynton, BA, Jaqueline Ndirangu, MPH, and Susan Furth, MD, PhD. Seminars in Nephrology, Vol 30, No 1, January 2010, pp 26-32 3. Impact of Gender on Access to the Renal Transplant Waiting List for Pediatric and Adult Patients PUSHKAL P. GARG, SUSAN L. FURTH, BARBARA A. FIVUSH, and NEIL R. POWE. J Am Soc Nephrol 11: 958–964, 2000