{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T18:54:02Z","timestamp":1788893642408,"version":"build-2803163510"},"reference-count":51,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2020,11,12]],"date-time":"2020-11-12T00:00:00Z","timestamp":1605139200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100011937","name":"Nieders\u00e4chsische Ministerium f\u00fcr Wissenschaft und Kultur","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100011937","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Background<\/jats:title><jats:p>Renal transplantation access and outcome differ between men and women, but no analysis has considered all transition phases and transplant outcome using the same data set. We analyzed sex disparities in all phases of patients\u2019 clinical path (progression to dialysis, waitlisting, transplantation, graft failure\/death).<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Methods<\/jats:title><jats:p>In a population based approach using health insurance data (2005\u20132013) we examined patients\u2019 risk of changing from one phase to another applying Cox Proportional Hazards model.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Results<\/jats:title><jats:p>After adjusting for age and comorbidities, women had a 16% lower risk of progression to ESRD (HR\/95%-CI: 0.84\/0.79\u20130.88). Access to the waitlist was lowered by 18% in women compared to men (HR\/95%-CI: 0.82\/0.70\u20130.96). An age stratified analysis did not reveal differences in any age group. Once waitlisted, the chance to receive a transplant was identical (HR\/95%-CI: 0.96\/0.81\u20131.15). The risk of transplant failure\/death was identical for both sexes (HR\/95%-CI: 0.99\/0.73\u20131.35), but the effect was modified by age: in younger women (18\u201345 years) the risk was twice as high compared to men (HR\/95%-CI: 2.08\/1.04\u20134.14), whereas the risk in elderly women (&gt; 65 years) was only half the risk of men (HR\/95%-CI: 0.47\/0.24\u20130.93).<\/jats:p><\/jats:sec><jats:sec id=\"sec004\"><jats:title>Conclusion<\/jats:title><jats:p>Sex disparities occurred at different steps in the history of patients with renal disease and affected progression to dialysis, waitlisting and transplantation outcome in a population with equal access to medical treatment.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0241556","type":"journal-article","created":{"date-parts":[[2020,11,12]],"date-time":"2020-11-12T18:37:11Z","timestamp":1605206231000},"page":"e0241556","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":30,"title":["Sex disparities in dialysis initiation, access to waitlist, transplantation and transplant outcome in German patients with renal disease\u2014A population based analysis"],"prefix":"10.1371","volume":"15","author":[{"given":"Anette","family":"Melk","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard M. W.","family":"Schmidt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siegfried","family":"Geyer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jelena","family":"Epping","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2020,11,12]]},"reference":[{"key":"pone.0241556.ref001","doi-asserted-by":"crossref","first-page":"2594","DOI":"10.1001\/archinte.1988.00380120056011","article-title":"Access to kidney transplantation. 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