Abstract
(1) Background: Interest in gender disparities in epidemiology, clinical features, prognosis and health care in chronic kidney disease patients is increasing. Aims of the study were to evaluate the association between gender and vascular access (arteriovenous fistula (AVF) or central venous catheter (CVC)) used at the start of hemodialysis (HD) and to investigate the association between gender and 1-year mortality. (2) Methods: The study includes 9068 adult chronic HD patients (64.7% males) registered in the Lazio Regional Dialysis Register (January 2008–December 2018). Multivariable logistic regression models were used to investigate the associations between gender and type of vascular access (AVF vs. CVC) and between gender and 1-year mortality. Interactions between gender and socio-demographic and clinical variables were tested adding the interaction terms in the final model. (3) Results: Females were older, had lower educational level and lower rate of self-sufficiency compared to males. Overall, CVC was used in 51.2% of patients. Females were less likely to use AVF for HD initiation than males. 1354 out of 8215 (16.5%) individuals died at the end of the follow-up period. Interaction term between gender and vascular access was significant in the adjusted model. From stratified analyses by vascular access, OR female vs. male (AVF) = 0.65; 95% CI 0.48–0.87 and OR female vs. male (CVC) = 0.88; 95% CI 0.75–1.04 were found. (4) Conclusions: This prospective population-based cohort study in a large Italian Region showed that in females starting chronic HD AVF was less common respect to men. The better 1-year survival of females is more evident among those women with AVF. Reducing gender disparity in access to AVF represents a key point in the management of HD patients.
Highlights
Chronic kidney disease (CKD) is a global health burden and an important risk factor for cardiovascular disease
It was found that odds ratios (OR) and 95% confidence interval of 1-year mortality of females versus males moved from 1.08 to 0.84 overall after adjusting for age at incidence, BMI, self-sufficiency, and cause of end-stage renal disease (ESRD)
This large population-based cohort study shows a significant difference in the vascular access for HD initiation between men and women, only 30% of females started using an Arteriovenous fistula (AVF)
Summary
Chronic kidney disease (CKD) is a global health burden and an important risk factor for cardiovascular disease. According to the 2019 Annual Data Report by United States Renal Data System the overall prevalence of CKD (stages 1–5) increased from 13.8% in 2016 to 14.5% in 2017 [2]. This trend reflects the increasing number of incident cases and the longer survival of patients with end-stage renal disease (ESRD) in renal replacement therapy. In 2017, CKD affected 99.457 persons (55.8% males) in Lazio Region, with a crude prevalence of 1.76%, 2.06% among males and 1.50% among females [3], reflecting the European general sex distribution in hemodialysis (HD) despite the higher proportion of females in the general population [4,5]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
