Renal replacement therapy (RRT) is a life-saving intervention for individuals with end-stage renal disease (ESRD). This intervention, which includes dialysis and kidney transplantation, plays a crucial role in the management of individuals with ESRD.

Although the clinical benefits of RRT are well established, disparities in access to and utilization of RRT exist among different population subgroups. One such subgroup is women. This review provides an overview of gender disparities in RRT and explores potential explanations for these disparities.

Gender disparities in access to RRT

Studies have consistently shown that women are less likely than men to initiate RRT.

For example, a population-based study in Canada found that women were 6% less likely than men to initiate RRT, even after adjusting for sociodemographic factors and comorbidities. Similarly, a study in the United States found that women were 15% less likely than men to initiate RRT. These disparities in access to RRT have been observed across different countries and healthcare systems.

Gender disparities in utilization of RRT

Even among individuals who initiate RRT, gender disparities in utilization exist. For instance, women are more likely than men to discontinue dialysis prematurely or to be placed on less frequent dialysis schedules.

Additionally, women receive kidney transplants less frequently than men. A study in Norway found that women were 22% less likely than men to receive a kidney transplant.

Explanations for gender disparities in RRT

Several explanations have been proposed to account for gender disparities in RRT. One explanation is that women tend to have lower levels of nephrology referral, which can result in delayed initiation of RRT.

A study in Canada found that women were less likely than men to be referred to a nephrologist prior to initiating RRT. Additionally, women are more likely than men to have comorbidities that may influence healthcare providers’ decisions regarding the timing and modality of RRT.

For example, women are more likely than men to have diabetes, which is associated with a higher risk of cardiovascular disease and mortality.

Another explanation is that women may face structural barriers to accessing RRT. For instance, women may have competing caregiving responsibilities that limit their ability to attend dialysis appointments or to comply with complex medication regimens.

Additionally, women are more likely than men to live in poverty, which can influence their ability to access healthcare services.

Implications for clinical practice

The disparities in access to and utilization of RRT among women have important implications for clinical practice. Healthcare providers should be aware of these disparities and take steps to ensure that women have equitable access to RRT.

This may involve increasing nephrology referral rates among women and addressing structural barriers to RRT utilization, such as transportation and childcare needs. Additionally, healthcare providers should consider the unique clinical needs of women in their decision-making regarding the timing and modality of RRT.

Conclusion

Gender disparities in RRT exist at both the access and utilization stages. These disparities may be due to a combination of factors, including lower levels of nephrology referral among women and structural barriers to accessing RRT.

Healthcare providers should be aware of these disparities and take steps to ensure that women have equitable access to RRT.