School of Medicine and Public Health, University of Wisconsin-Madison, USA.
Division of Nephrology, Department of Medicine, University of Wisconsin-Madison Hospital and Clinics, USA.
Perit Dial Int. 2020 Jan;40(1):57-61. doi: 10.1177/0896860819878656.
Overall, a disproportionately small number of end-stage renal disease (ESRD) patients start peritoneal dialysis (PD) in the United States compared to hemodialysis. Little is known about whether gender has an effect on the initial modality of renal replacement therapy utilized by patients; however, prior studies have demonstrated gender disparities in the diagnosis and treatment of various other health conditions, including kidney disease.
Using data from the United States Renal Data System (USRDS), we estimated the proportion of patients utilizing PD as their initial dialysis modality between 2000 and 2014, adjusting estimates to the mean value of all covariates and compared these estimates for women and men.
We found that 7.9% of women and 7.5% of men used PD as their initial dialysis modality. The unadjusted odds ratio (OR) of women initiating PD as their initial modality compared to men was 1.04 (95% CI 1.02-1.05, < 0.001). After adjustment for age, race, ethnicity, cause of ESRD, number of comorbidities, income, employment status, and timing of referral to nephrology, the difference was even more significant, with women being 12% (OR 1.12, CI 1.10-1.14, < 0.001) more likely to initiate PD than men. However, within different subgroups, older women and women with higher number of comorbidities were less likely to be on PD than their male counterparts.
Our results indicate that gender plays a role in the initial dialysis modality used by patients and providers should be cognizant of these gender differences. Further studies are needed to ascertain the cause of this observed difference.
与血液透析相比，美国终末期肾病（ESRD）患者开始腹膜透析（PD）的比例不成比例地较小。关于性别是否会影响患者最初使用的肾脏替代治疗方式，目前知之甚少；然而，先前的研究表明，在包括肾脏疾病在内的各种其他健康状况的诊断和治疗方面，存在性别差异。
我们使用美国肾脏数据系统（USRDS）的数据，估计了 2000 年至 2014 年期间，患者使用 PD 作为初始透析方式的比例，将估计值调整为所有协变量的平均值，并比较了女性和男性的这些估计值。
我们发现，7.9%的女性和 7.5%的男性使用 PD 作为他们的初始透析方式。与男性相比，女性开始 PD 作为初始治疗方式的未调整比值比（OR）为 1.04（95%CI 1.02-1.05，<0.001）。在调整年龄、种族、民族、ESRD 病因、合并症数量、收入、就业状况以及转至肾病科的时机等因素后，差异更为显著，女性开始 PD 的可能性比男性高 12%（OR 1.12，CI 1.10-1.14，<0.001）。然而，在不同的亚组中，年龄较大的女性和合并症较多的女性使用 PD 的可能性低于其男性同行。
我们的研究结果表明，性别在患者和提供者选择初始透析方式中起作用，医生应意识到这些性别差异。需要进一步研究以确定这种观察到的差异的原因。
