Hemodialysis Used Less Often for Women than Men with End-Stage Renal Disease (ESRD)

59% of men with ESRD were on hemodialysis versus 41% of women.
59% of men with ESRD were on hemodialysis versus 41% of women.

Fewer women than men with end-stage renal disease (ESRD) are treated with hemodialysis (HD), regardless of age group, according to findings from the ongoing Dialysis Outcomes and Practice Patterns Study (DOPPS).

A team led by Manfred Hecking, MD, of the Medical University of Vienna in Austria, studied 35,964 DOPPS patients from 12 countries and found that, overall, 59% of men with ESRD were on HD compared with 41% of women. In all 12 countries, fewer women than men were on HD. The average estimated glomerular filtration rate (eGFR) at HD initiation was higher in men than women, the researchers reported online in PLOS Medicine. In addition, compared with women, men had a mean younger age (61.9 vs. 63.1 years) and they were less frequently obese, more frequently married.

The study also showed that the survival advantage that women have over men in the general population was markedly decreased in the HD population. “The finding that the general survival advantage for women is virtually lost for all adult age groups of individuals on dialysis is striking,” the authors wrote.

Dr. Hecking's group explained that the finding that fewer women than men were on HD treatment in all DOPPS countries could in principle be related to differences in treatment modality for ESRD (in-center HD vs. home HD vs. and peritoneal dialysis [PD]). Both the U.S. Renal Data System and the Canadian Organ Replacement Registry, however, have shown that the incidence and prevalence of PD and home HD are higher in men than women, and more men had received a kidney transplant preemptively, the investigators pointed out.

“Whether men and women differ by dialysis initiation and chronic kidney disease care is perhaps the most important question raised by the present study,” Dr. Hecking and his colleagues concluded. “This question is not novel, as national data have been available for decades, but may not previously have been asked as clearly as by the present analysis with a large sample size and international perspective.”

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