Univ Rennes, EHESP, CNRS, Inserm, Arènes-UMR 6051, RSMS (Recherche sur les Services et Management en Santé), Rennes, France.
Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail), Rennes, France.
PLoS One. 2024 Mar 27;19(3):e0299601. doi: 10.1371/journal.pone.0299601. eCollection 2024.
In the last two decades, sex and gender differences have been documented in chronic kidney disease (CKD) management, including access to renal replacement therapy and its outcomes. The objectives of this study were to 1) compare the pre-dialysis healthcare utilization in men and women, and 2) examine the sex-specific factors associated with emergency dialysis start.
Adult patients with CKD who started dialysis in France in 2015 were extracted from the Renal Epidemiology and Information Network registry. Patients were matched to the French National Health Data System database to extract healthcare utilization data for the 2 years before dialysis start. Frequencies and monthly rates of consultations and hospitalizations were compared between men and women. Logistic regression analyses were performed separately in the two groups.
Among the 8856 patients included, 3161 (35.7%) were women. Median age (71 years) and estimated glomerular filtration rate (8.1 and 7.7 ml/min for men and women) were similar between groups at dialysis start. Monthly consultations rates with a general practitioner and nephrology-related care were similar between women and men. Some sex-specific differences were found: higher frequencies of consultations with a psychiatrist in women and more frequent hospitalizations for circulatory system diseases in men. Emergency dialysis start rate was 30% in both groups. Emergency dialysis start was associated with acute nephropathy, compared with slowly progressive nephropathy, in women but not in men (OR = 1.48, p<0.01 vs 1.15, p = 0.18).
This study found similar quantitative pre-dialysis healthcare utilization in men and women. To better understand sex/gender differences in CKD care trajectories, future research should focus on patients with CKD who are unknown to nephrology services, on patients receiving conservative care and on the sex/gender-specific mechanisms underlying care decision-making.
在过去的二十年中，慢性肾脏病（CKD）管理中的性别差异已得到证实，包括接受肾脏替代治疗及其结果。本研究的目的是：1）比较男性和女性在透析前的医疗保健利用情况，2）检查与急诊透析开始相关的性别特异性因素。
从法国肾脏流行病学和信息网络登记处提取 2015 年开始透析的成年 CKD 患者。将患者与法国国家健康数据系统数据库相匹配，以提取透析前 2 年的医疗保健利用数据。比较了男性和女性之间的就诊和住院频率和月率。在两组中分别进行了逻辑回归分析。
在纳入的 8856 例患者中，有 3161 例（35.7%）为女性。在开始透析时，两组患者的中位年龄（71 岁）和估计肾小球滤过率（男性和女性分别为 8.1 和 7.7 ml/min）相似。女性和男性与全科医生和肾脏科相关护理的就诊率相似。发现了一些性别特异性差异：女性看精神科的频率更高，而男性因循环系统疾病住院的频率更高。两组的急诊透析开始率均为 30%。在女性中，与缓慢进展性肾病相比，急性肾病与急诊透析开始相关，而在男性中则不然（OR=1.48，p<0.01 比 1.15，p=0.18）。
本研究发现男性和女性透析前的医疗保健利用情况相似。为了更好地理解 CKD 护理轨迹中的性别差异，未来的研究应侧重于尚未被肾病科服务发现的 CKD 患者、接受保守治疗的患者以及护理决策背后的性别特异性机制。
