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Disparities in Kidney Transplants Between Men and Women


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Chronic kidney disease is an illness in which an individual gradually loses the functioning of their kidney over a series of five stages (Fraser & Blakeman, 2016). The fifth or final stage of this condition is referred to as either end-stage renal disease or end-stage kidney disease (Mayo Clinic, n.d.). End-stage renal disease is the most serious stage of chronic kidney disease during which the kidneys are irreversibly damaged (Mayo Clinic, n.d.). Not surprisingly, if this condition is not treated in an appropriate and timely manner, it may lead to the death of the patient (Elsharif, 2011).


The recommended treatment for end-stage kidney disease is called renal replacement therapy, which can be delivered through either a dialysis or a kidney transplant (Kaballo et al., 2018). Among patients diagnosed with end-stage renal disease, hemodialysis is received by nearly two-thirds of the individuals while peritoneal dialysis is received by only one-tenth of these patients in countries that have a high prevalence of the disease (Abbassi et al., 2020). A quarter of the individuals diagnosed with end-stage kidney disease in such regions undergo kidney transplantation (Abbassi et al., 2020). As compared to dialysis, kidney transplantation not only provides individuals with a longer life, but also one of improved quality (Kaballo et al., 2018; Maglakelidze et al., 2011; Yoo et al., 2016). Thus, kidney transplantation is considered the optimal treatment for end-stage renal disease (Abecassis et al., 2008).


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Renal transplants can be broadly divided into two types: deceased donor kidney transplants and living kidney donor transplants. In the former process, the kidney is received from a donor that has been declared dead either due to a complete and irreversible cessation of brain functioning or the irreversible cessation of the function of the circulatory system (Sade, 2012). In contrast, living donor kidney transplants come from people who are alive, and they have additional benefits and better outcomes when compared to deceased donor transplants. For instance, it has been demonstrated that living donor transplants, when compared to deceased donor transplants, lead to a larger increase in an individual’s lifespan while also providing them with greater improvements in their quality of life (Gozdowski et al., 2016; Nemati et al., 2014).


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Despite the rising concern about the increasing prevalence of end-stage renal disease and the consequences associated with its diagnosis, access to kidney transplantation has remained inequitable. More specifically, access to renal transplant is more limited for female patients than it is for male patients. Current evidence provides evidence that women donate their kidneys more frequently than their male counterparts (Dobson, 2002). Unfortunately, female patients diagnosed with end-stage renal disease encounter significant disparities at multiple steps during the entire transplantation process when compared to male patients with the same diagnosis.

Women diagnosed with end-stage kidney disease have a lower likelihood of undergoing living donor kidney transplantation than men diagnosed with the condition. Likewise, female patients also have lower rates of receiving a deceased donor kidney transplant when compared to their male counterparts (Hart et al., 2017). That seems like a lot, but it does not stop there! Research has demonstrated that female patients also have a slower rate of completing the mandatory eligibility testing conducted prior to transplant (Monson et al., 2015). In addition, female patients with end-stage kidney disease experience a lower chance of making it to the transplant waiting list than their male counterparts, which further makes them less likely to find a matching kidney and, thus, receive a transplant (John Hopkins Medicine, 2009).


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Inequity in transplants between males and females inevitably prompts us to question why these differences exist. The answer, however, is not simple. It has been suggested that this inequity may stem from male and female patients having different health-seeking behaviors or attitudes towards treatment. Some have pointed towards the possibility of socially ingrained gender roles while others have said that there may be differences in healthcare provider attitudes. In reality, we are not quite aware of the precise reason behind this disparity, and the research surrounding this area has primarily focused on the extent of the inequity rather than the underlying causes behind it. As such, it is incredibly important that researchers and clinicians alike pay closer attention to this issue in order to detect and eliminate potential causal factors. In turn, this would ensure more equitable access to renal transplantation in female patients diagnosed with end-stage kidney disease.


References

  • Abbasi, M. A., Chertow, G. M., & Hall, Y. N. (2010). End-stage renal disease, BMJ Clin Evid. https://www.ncbi.nlm.nih.gov/pubmed/21418665

  • Abecassis, M. M., Burke, R., Cosimi, A. B., Matas, A. J., Merion, R. M., Millman, D., Roberts, J. P., & Klintman, G. B. (2008). Transplant center regulations-a mixed blessing? An ASTS Council viewpoint. Am J Transplant, 8(12), 2496-2502. https://doi.org/10.1111/j.1600-6143.2008.02434.x

  • Dobson R. (2002). More women than men become living organ donors. BMJ : British Medical Journal, 325(7369), 851. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1124370/

  • Elsharif M. E. (2011). Mortality rate of patients with end stage renal disease on regular hemodialysis: a single center study. Saudi Journal of Kidney Diseases and Transplantation, 22(3), 594–596. https://pubmed.ncbi.nlm.nih.gov/21566330/

  • Fraser, S. D. & Blakeman, T. (2016). Chronic kidney disease: Identification and management in primary care. Pragmat Obs Res, 7, 21-32. https://doi.org/10.2147/POR.S97310

  • Gozdowska, J., Zatorski, M., Torchalla, P., Bialek, L., Bojanowska, A., Tomaszek, A., Serwanska-Sweitek, M., Kieszek, R., Kwiatkowski, A., Chmura, A., & Durlik, M. (2016). Living-donor versus deceased-donor kidney transplantation: Comparison of psychosocial consequences for recipients. Transplant Proc, 48(5), 1498-1505. https://doi.org/10.1016/j.transproceed.2016.01.075

  • Hart, A., Smith, J. M., Skeans, M. A., Gustafson, S. K., Stewart, D. E., Cherikh, W. S., Wainright, J. L., Kucheryavaya, A., Woodbury, M., Snyder, J. J., Kasiske, B. L., & Israni, A. K. (2017). OPTN/SRTR 2015 annual data report: Kidney. American Journal of Transplantation, 17 Suppl 1(Suppl 1), 21–116. https://doi.org/10.1111/ajt.14124

  • John Hopkins Medicine. (2009). Older women are less likely than men to be listed for kidney transplants. https://www.hopkinsmedicine.org/news/media/releases/older_women_less_likely_than_men_to_be_listed_for_kidney_transplants

  • Kaballo, M. A., Canney, M., O’Kelly, P., Williams, Y., O’Seaghdha, C. M., & Conlon, P. J. (2018). A comparative analysis of survival of patients on dialysis and after kidney transplantation. Clin. Kidney J, 11(3), 389-393. https://doi.org/10.1093/ckj/sfx117

  • Maglakelidze, N., Pantsulaia, T., Managadze, L., & Chkhotua, A. (2011). Assessment of health-related quality of life in renal transplant recipients and dialysis patients. Transplant Proc, 43(1), 376-379. https://doi.org/10.1016/j.transproceed.2010.12.016

  • Mayo Clinic. (n.d.). End-stage renal disease. https://www.mayoclinic.org/diseases-conditions/end-stage-renal-disease/symptoms-causes/syc-20354532

  • Monson, R. S., Kemerley, P., Walczak, D., Benedetti, E., Oberholzer, J., & Danielson, K. K. (2015). Disparities in completion rates of the medical prerenal transplant evaluation by race or ethnicity and gender. Transplantation, 99(1), 236–242. https://doi.org/10.1097/TP.0000000000000271

  • Nemati, E., Einollahi, B., Lesan Pezeshki, M., Porfarziani, V., & Fattahi, M. R. (2014). Does kidney transplantation with deceased or living donor affect graft survival?. Nephro-urology monthly, 6(4), e12182. https://doi.org/10.5812/numonthly.12182

  • Sade R. M. (2011). Brain death, cardiac death, and the dead donor rule. Journal of the South Carolina Medical Association (1975), 107(4), 146–149. https://pubmed.ncbi.nlm.nih.gov/22057747/

  • Yoo, K. D., Kim, C. T., Kim, M. H., Noh, J., Kim, G., Kim, H., An, J. N., Park, J. Y., Cho, H., Kim, K. H., Kim, H., Ryu, D. R., Kim, D. K., Lim, C. S., Kim, Y. S., & Lee, J. P. (2016). Superior outcomes of kidney transplantation compared with dialysis: An optimal matched analysis of a national population-based cohort study between 2005 and 2008 in Korea. Medicine (United States), 95(33), 274. https://doi.org/10.1097/MD.0000000000004352

 
 
 

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