Women at disadvantage – sex differences in time between dialysis initiation and kidney transplant evaluation or listing: a single-center experience

Kidney transplantation remains the most effective treatment for end-stage kidney disease, but sociodemographic differences, including sex and gender differences, remain a significant challenge. There is evidence that women receive fewer transplants than men, but whether gender influences the timing of transplant evaluation and waitlisting has not been analyzed yet. Therefore, we aimed to investigate gender differences in the time intervals between dialysis initiation, transplant evaluation and waitlisting. We retrospectively analyzed 182 patients listed for kidney transplantation in the last quarter of 2023 (Key date 1st October 2023) or positively evaluated for listing for kidney transplantation from 2017 to 2023 at the University Medical Center Marburg, Germany. Besides baseline characteristics, we collected data on dialysis initiation, start of transplant evaluation and time from evaluation to waitlisting (Ethics approval Nr. 24-97RS, Philipps University Marburg, Germany). In our cohort, we did not find significant overall gender differences in the time intervals from dialysis initiation to transplant evaluation or listing. However, male patients undergoing peritoneal dialysis or scheduled for living donor transplants had significantly shorter evaluation and waitlisting times compared to their female counterparts. The findings from our single-center analysis with a limited sample size suggest that gender disparities are pronounced in specific subgroups, with men generally benefiting from faster access to the waitlist. The results highlight the importance of recognizing gender disparities in transplantation processes to ensure equitable access for all patients. Future research should focus on interventions that address these inequalities and promote gender-sensitive nephrology care.