Factors contributing to gender disparity in access to kidney replacement therapy in pediatric population in various regions of India: prospective observational multicenter study

Background: Gender disparity in access to kidney replacement therapy (KRT) among children with chronic kidney failure (CKF) has been a longstanding concern in India. However, there have been no studies undertaken to evaluate the presence, extent and causes of any gender disparity.
Methods: We conducted a prospective multi-center observational study of children (< 18 years of age) with CKF 3 to 5, attending the nephrology clinics across five tertiary centers in India over a period of 18 months. Demographic, socioeconomic, clinical, and treatment-related parameters were analyzed to assess gender-related differences in presentation and access to KRT.
Results: Of the 420 children enrolled 127 were girls (30.2%) and 293 were boys (69.8%), with a M:F ratio of 2.2:1 with significant variation in gender distribution across centers (χ²=14.53, p=0.06). Girls were older at presentation (7.0±4.9 vs. 5.7±4.8 years; p=0.01) and had a shorter interval for progression from presentation to CKF (2.1±3.4 vs. 3.5±4.1 years; p=0.001). Disease etiology differed by gender, with CAKUT predominating in boys (72.7% vs. 39.4%) and glomerulonephritis, cystic kidney disease, and podocytopathies in girls (all p<0.001). No significant gender differences were observed in socioeconomic determinants, willingness for transplantation, KRT modality, or actual receipt of transplant.
Conclusions: Gender bias was noted at the time of presentation to the nephrology clinics with a M:F ratio of 2.2:1 as opposed to global ratio of 1.8 :1. There was significant regional variation in the gender distribution with the worst ratios in the western region (3:1) and the best in the East (0.8:1).Girls also presented at a later age and the time for progression to CKF from presentation was shorter. Gender bias seems to be prevalent independent of religious beliefs, educational and economic status of parents or family structure.