MedUni Vienna: Women receive dialysis treatment less often than men

Women with chronic kidney disease receive dialysis treatment far less often than men. However, women suffer more commonly than men from kidney disease.  A publication by the MedUni Vienna and the Arbor Research Collaborative for Health, USA, has highlighted this difference based on international patient data.

In chronic kidney disease, regular haemodialysis (blood washing) or a kidney transplant are often the only way to keep patients alive. A study group at the MedUni Vienna and the Arbor Research Collaborative for Health (Ann Arbor, Michigan, USA) has now discovered, using collected patient data, that women receive dialysis treatment much less often than men. Statistically, however, women suffer from kidney disease more frequently than men.

Patient data has been collected in the Dialysis Outcomes and Practice Patterns Study (DOPPS) since 1996 and subjected to scientific analysis. This data (obtained from over 206,000 patients) was investigated for gender differences by Manfred Hecking, Marcus Säemann and Gere Sunder-Plassmann (Department of Nephrology and Dialysis, University Department of Internal Medicine III), as well as Alexandra Kautzky-Willer (Gender Medicine Unit, Department of Endocrinology and Metabolism, University Department of Internal Medicine III) in cooperation with scientists led by Friedrich Port from the Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA. The data showed that, in all twelve countries involved in the analysis (Australia, Belgium, Canada, France, Germany, Italy, Japan, Spain, Sweden, the United Kingdom and the USA), more men were treated with dialysis. On average, the percentage distribution was 59 (men) to 41 per cent (women), with further differences being noted between the individual countries. "The gender difference applies across all age groups", explains primary author Manfred Hecking, "and significantly more men than women start dialysis treatment, too. This is of particular note since women - contrary to popular assumptions - suffer from chronic kidney disease (CKD) more often than men." Austria is not involved with the DOPPS study, however Marcus Säemann and Gere Sunder-Plassmann report clear gender differences in the country after taking a look at the Austrian dialysis registry. "In Austria, the current proportion of female dialysis patients is actually below the international average at 37 per cent."

The search for the cause
There may be several reasons for these differences, says the study group. "There are likely fewer biological reasons than socio-economic ones that are causing this discrepancy," says gender expert Alexandra Kautzky-Willer from the MedUni Vienna. "We have analysed this in great detail in the context of the publication based on studies that have already been published." In the individual countries, different access modalities as well as social imbalances between the genders may make this discrepancy even greater (such as in Australia, in the group of over-75-year-olds) or less (such as in the same age group in the USA and Canada). This indeed very marked difference between the countries would at least indicate non-biological reasons. Further studies - such as a standardised enquiry to CKD outpatient clinics which is already planned - will hopefully cast some light on the reasons for these international gender differences that have now been recognised comprehensively for the first time.

Service: PLOS Medicine
Sex-Specific Differences in Hemodialysis Prevalence and Practices and the Male-to-Female Mortality Rate: The Dialysis Outcomes and Practice Patterns Study (DOPPS)
Manfred Hecking, Brian A. Bieber, Jean Ethier, Alexandra Kautzky-Willer, Gere Sunder-Plassmann, Marcus D. Säemann, Sylvia P. B. Ramirez, Brenda W. Gillespie, Ronald L. Pisoni, Bruce M. Robinson, Friedrich K. Port

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