Sex Differences in Kidney Replacement Therapy Initiation and Maintenance

Abstract

Background and objectives More men than women undergo kidney replacement therapy (KRT) despite a larger number of women being affected by CKD. The aim of this multinational European study was to explore whether there might be historic and geographic trends in sex-specific incidence and prevalence of various KRT modalities. Design, setting, participants, & measurements We assessed sex-specific differences in KRT incidence and prevalence using data from nine countries reporting to the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Registry for at least 40 years, during the period 1965-2015. Sex distribution data were compared with the European general population (Eurostat). Statistical methodology included basic descriptive statistics, incidence and prevalence calculations per million population (pmp), as well as their male-tofemale ratios. Analyses were stratified by age group and diabetic status. Results We analyzed data from 230,378 patients receiving KRT (38% women). For all KRT modalities, the incidence and prevalence rates were consistently higher in men than women. For example, the KRT incidence increased from 8 pmp in 1965-1974 to 98 pmp in 2005-2015 in women, whereas it rose from 12 to 173 pmp in men during the same period. Male-to-female ratios, calculated for incident and prevalent KRT patients, increased with age (range 1.2-2.4), showing consistency over decades and for individual countries, despite marked changes in primary kidney disease (diabetes more prevalent than glomerulonephritis in recent decades). The proportion of kidney transplants decreased less with age in incident and prevalent men compared with women on KRT. Stratified analysis of patients who were diabetic versus nondiabetic revealed that the male-to-female ratio was markedly higher for kidney transplantation in patients with diabetes. Conclusions Since the beginning of KRT programs reporting to the ERA-EDTA Registry since the 1960s, fewer women than men have received KRT. The relative difference between men and women initiating and undergoing KRT has remained consistent over the last five decades and in all studied countries.

Sex Differences in Urate Handling

“…HUA is just one of many conditions that have observable sex differences, as differing pathologies based on sex have been observed in a variety of fields [14][15][16][17] including cardiovascular [18][19][20][21], neurological [22][23][24][25], immunological [26][27][28], and renal diseases [29][30][31][32][33]. The architecture of the female kidney is likely distinct from that of the male kidney [34], given women have a lower blood pressure than men [35], women are less likely to develop acute kidney injury than men [36,37], women demonstrate improved tolerance to renal ischemia [38,39], and women are protected from renal and cardiovascular disease before menopause as compared to men [40,41].…”

Gender medicine: Lessons from COVID-19 and other medical conditions for designing health policy

“…Gender-specific disparities have also been observed in the treatment of CKD[ 148 , 158 , 159 , 162 ]. More men undergo dialysis or KRT than women, despite the fact that more women are affected by CKD, especially stage G3 CKD.…”

Gender, Albuminuria and Chronic Kidney Disease Progression in Treated Diabetic Kidney Disease

“…There is recent interest in and controversy over the reasons behind the lower incidence of renal replacement therapy (RRT) in women, despite a higher prevalence of chronic kidney disease (CKD) [1][2][3]. The concern that this may represent, that is, decreased access of women to RRT, has been raised [4].…”