Objectives: Gender inequity exists in organ transplantation, showing large difference in female fractions for living kidney donors or recipients. The aim of this study is to describe the twenty-year status on gender equity in dialysis and kidney transplantation (KT). Methods: Retrospective data for incident dialysis, newly registered waiting list, and KT donors and recipients is retrospectively collected. The data for dialysis patients between 2000 and 2020 is from Korean Society of Nephrology (KSN) end-stage renal disease (ESRD) registry. The data for waiting list and KT is from database of Korean Network for Organ Sharing (KONOS). The trend of female proportion in dialysis, waiting list, KT donors and recipients over 20 years is analyzed with the jointpoint regression model.  Results: The average proportion of female in dialysis for twenty years is 40.5%. The proportion of female in dialysis showed decreasing trend (Annual percent change (APC) is -0.76, 95% CI -0.9~-0.7, P<0.1). The proportion of female in 2000 was 42.8%, peaked 44.0% in 2002 and decreasing to 38.2% in 2020. The average female proportion in waiting list is 38.4%, which is lower than in dialysis. The average proportion of female recipient in living donor KT is 40.1%, whereas female living donor is 53.2%. The overall female donor in living donor KT showed increasing trend (APC 1.26, CI 1.0-1.5, P <0.001), due to increase in absolute number of donation from wives. However, female recipients in living donor KT showed no change (APC 0.1, 95% CI -0.2~0.5, P = 0.421). Female proportion in incident dialysis is decreasing, following decreasing trend in waiting list, and deceased donor KT recipients sequentially. Conclusions: Gender inequity existed, showing increasing trend of female donors in LDKT. More attention is needed to identify biological and socioeconomic factors to resolve gender inequality.