Fewer women than men are treated with dialysis for end-stage kidney disease, according to a new comprehensive analysis of sex-specific differences in treatment published this week in PLOS Medicine. The results of the study, conducted by Manfred Hecking with Friedrich Port and colleagues from Arbor Research Collaborative for Health in Ann Arbor, Michigan, suggest that these findings call for further detailed study for the reasons underlying the sex-specific differences in end-stage renal disease treatment.
Chronic kidney disease often progresses to end-stage renal disease, which is treated by regular hemodialysis (a process in which blood is purified by passing it through a filtration machine) or by kidney transplantation. In this study, the authors performed an analysis of sex-specific differences among individuals with end-stage kidney disease to identify both treatment inequalities and ways to improve sex-specific care using the Dialysis Outcomes and Practice Patterns Study (DOPPS). The DOPPS is a prospective cohort study that is investigating the characteristics, treatment, and outcomes of adult patients undergoing hemodialysis in representative dialysis facilities in 19 countries.
12 of the 19 countries, including 206,374 patients, were studied by the researchers to determine what, if any, sex-specific differences existed in the prevalence and practices of hemodialysis and the male-to-female mortality rate among patients undergoing hemodialysis. Then, data from the Human Mortality Database of the World Health Organization, which provides detailed population and mortality data for the same countries, was compared with the data collected by the DOPPS. The authors found that women's survival after hemodialysis is virtually equal to men's survival, however, women were not receiving hemodialysis treatment as early as men, which could lead to higher mortality before treatment. Overall, this study showed that more men than women were on hemodialysis (59% versus 41%), while previous literature reports that chronic kidney disease tends to be more common in women overall. Men were also more frequently recipients of a kidney transplant than women.
The findings in this paper indicate that for hemodialysis patients the survival advantage that women have over men in the general population is decreased and that fewer women than men are being treated for end-stage-renal disease. Although some of these sex-specific differences found in hemodialysis treatment may be related to biology, other factors may include patient care and patient awareness of chronic kidney disease. The authors argue for more studies into the observed difference in hemodialysis treatment, writing "The finding that fewer women than men were being treated with dialysis for end-stage renal disease merits detailed further study, as the large discrepancies in sex-specific hemodialysis prevalence by country and age group are likely explained by factors beyond biology."
Funding: The DOPPS Program is supported by Amgen, Kyowa Hakko Kirin, AbbVie Inc., Sanofi Renal, Baxter Healthcare, and Vifor Fresenius Medical Care Renal Pharma, Ltd. Additional support for specific projects and countries is also provided in Canada by Amgen, BHC Medical, Janssen, Takeda, Kidney Foundation of Canada (for logistics support); in Germany by Hexal, DGfN, Shire, WiNe Institute; and for PDOPPS in Japan by the Japanese Society for Peritoneal Dialysis (JSPD). All support is provided without restrictions on publications. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The corresponding author has had full access to all the data in the study and takes final responsibility for the decision to submit for publication and the integrity of the data and accuracy of the manuscript.
Competing Interests: BMR has received a speaker's fee from Kyowa Hakko Kirin. RLP has received speaker's fees from Amgen, Kyowa Hakko Kirin, and Vifor and has served on an advisory panel for Merck. The other authors have declared that no competing interests exist.
Citation: Hecking M, Bieber BA, Ethier J, Kautzky-Willer A, Sunder-Plassmann G, et al. (2014) Sex-Specific Differences in Hemodialysis Prevalence and Practices and the Male-to-Female Mortality Rate: The Dialysis Outcomes and Practice Patterns Study (DOPPS). PLoS Med 11(10): e1001750. doi:10.1371/journal.pmed.1001750
Medical University of Vienna, AUSTRIA
Arbor Research Collaborative for Health, UNITED STATES
Centre Hospitalier de l'Universite de Montreal, CANADA
University of Michigan, UNITED STATES
Friedrich K. Port
Arbor Research Collaborative for Health
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