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Men more likely to receive kidney replacement therapy than women
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Although women have higher rates of chronic kidney disease, men have consistently been more likely to initiate dialysis or receive a kidney transplant during the course of 5 decades, according to a recently published study. Researchers are still unsure as to the reasons for the observed disparities.
“The supporters of biology as the root-cause of why fewer women than men initiate dialysis may now state that the phenomenon is so stable, it has to be biological,” Manfred Hecking, MD, PhD, associate professor of internal medicine at the Medical University of Vienna's department of internal medicine III, clinical division of nephrology and dialysis, said in a press release. “And the supporters of disparity as the root-cause of why fewer women than men initiate dialysis may now state that disparity is just a constant obstacle, which simply has not been overcome yet.”
Hecking elaborated on this, telling Healio/Nephrology, “We had been hypothesizing that there might be historical differences in sex-specific rates of kidney replacement therapy initiation and prevalence, perhaps going along with societal differences that might have occurred over the years. However, we found that the approximate relationship of 40% women vs. [of] 60% men on dialysis was remarkably stable in European countries reporting to the European Renal Association-European Dialysis and Transplant Association Registry over the last 5 decades, despite marked differences in primary renal disease (the reasons for kidney failure).”
To examine trends in sex distribution of those who initiated kidney replacement therapy (KRT) between 1965 and 2015, researchers included 230,378 patients from nine countries in their analysis, noting that hemodialysis was the most commonly used modality throughout the study period for all age groups.
They found that, for all KRT modalities, the incidence and prevalence rates were consistently higher in men than women (incidence rate rising from 9 per million population in 1975 to 1974 to 98 per million population in 2005 to 2015 for women vs. 12 per million population to 173 per million population for men).
In addition, male-to-female ratios for incident and prevalent KRT patients increased with age and remained stable during the study period. This result was consistent during the decades and for individual countries, with the male-to-female ratio being markedly higher for kidney transplantation in those who also had diabetes.
“The reasons for these observations are currently unclear,” the researchers wrote, proposing that unequal access to KRT, competing risks of dying before initiation or faster progression of CKD in men than women could all be affecting factors.
“We need to analyze data from the general population and tease out whether women with kidney disease in the pre-dialysis stage have a higher 'competing risk' of dying vs. initiating dialysis,” Hecking told Healio/Nephrology. “We should also conduct qualitative studies (interviews) among women and men with kidney disease to find out whether there are sex differences in kidney disease symptom burden, sex differences in support from caregivers and perceived sex differences in medical support.”
The researchers concluded: “As health inequalities perhaps due to gender disparity are potentially modifiable, it would be important to prove such a phenomenon as the underlying cause for the different sex distribution of CKD versus KRT patients. If inequalities in access to care have prevented women from reaching KRT, these disparities would then have remained remarkably stable over the last 50 years because otherwise they would not be the most important factor explaining the sex differences. This notion is, however, purely speculative, as the present study does not provide information on health care access.” – by Melissa J. Webb
Disclosures: Hecking reports receiving grants from Astellas Pharma, Boehringer Ingelheim, FWF - Austrian Science Fund and Siemens Healthcare. He also reports receiving personal fees from Siemens Healthcare.
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