Riehl-Tonn Victoria J, MacRae Jennifer M, Dumanski Sandra M, Elliott Meghan J, Pannu Neesh, Schick-Makaroff Kara, Drall Kelsea, Norris Colleen, Nerenberg Kara A, Pilote Louise, Behlouli Hassan, Gantar Taryn, Ahmed Sofia B
Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Libin Cardiovascular Institute, Calgary, Alberta, Canada.
Clin Kidney J. 2024 Sep 3;17(10):sfae273. doi: 10.1093/ckj/sfae273. eCollection 2024 Oct.
Women treated with hemodialysis report lower health-related quality of life (HRQoL) compared with men. Whether this is related to sex-specific (biological) (e.g. under-dialysis due to body composition differences) or gender-specific (sociocultural) factors (e.g. greater domestic/caregiver responsibilities for women) is unknown. We examined the association between sex assigned at birth, gender score and HRQoL in individuals initiating conventional and incremental hemodialysis.
In this prospective multi-center cohort study, incident adult hemodialysis patients were recruited between 1 June 2020 and 30 April 2022 in Alberta, Canada. Sex assigned at birth and gender identity were self-reported. Gender-related characteristics were assessed by self-administered questionnaire to derive a composite measure of gender. The primary outcome was change in Kidney Disease Quality of Life 36 physical (PCS) and mental (MCS) component scores after 3 months of hemodialysis.
Sixty participants were enrolled (conventional hemodialysis: 14 female, 19 male; incremental hemodialysis: 12 female, 15 male). PCS improved from baseline with conventional (= .01) but not incremental (= .52) hemodialysis in female participants. No difference in MCS was observed by hemodialysis type in female participants. Gender score was not associated with changes in PCS in female participants, irrespective of hemodialysis type. Higher gender score was associated with increased MCS with incremental (= .04), but not conventional (= .14), hemodialysis (= .03 conventional vs incremental) in female participants. No change in PCS or MCS was seen in male participants, irrespective of hemodialysis type or gender score.
In this exploratory study, conventional hemodialysis was associated with improved PCS in female participants, while incremental hemodialysis was associated with improved MCS in female participants with more roles and responsibilities traditionally ascribed to women. Large prospective studies are required to further investigate these relationships.
与男性相比，接受血液透析治疗的女性报告的健康相关生活质量（HRQoL）较低。尚不清楚这是与性别特异性（生物学）因素（例如由于身体成分差异导致透析不足）还是与性别特定（社会文化）因素（例如女性承担更大的家庭/照顾者责任）有关。我们研究了开始接受常规和增量血液透析的个体中出生时指定的性别、性别评分与HRQoL之间的关联。
在这项前瞻性多中心队列研究中，2020年6月1日至2022年4月30日期间在加拿大艾伯塔省招募了成年血液透析新发病例患者。出生时指定的性别和性别认同由患者自行报告。通过自我管理问卷评估与性别相关的特征，以得出性别综合测量值。主要结局是血液透析3个月后肾脏疾病生活质量36项身体（PCS）和精神（MCS）成分评分的变化。
共招募了60名参与者（常规血液透析：14名女性，19名男性；增量血液透析：12名女性，15名男性）。女性参与者中，常规血液透析（=0.01）可使PCS较基线有所改善，但增量血液透析（=0.52）则无此效果。女性参与者中，未观察到血液透析类型对MCS有差异。无论血液透析类型如何，女性参与者的性别评分与PCS变化均无关联。在女性参与者中，较高的性别评分与增量血液透析（=0.04）时MCS增加相关，但与常规血液透析（=0.14）时无关（常规与增量血液透析相比，P = 0.03）。无论血液透析类型或性别评分如何，男性参与者的PCS或MCS均无变化。
在这项探索性研究中，常规血液透析与女性参与者PCS改善相关，而增量血液透析与承担更多传统上归属于女性角色和责任的女性参与者MCS改善相关。需要开展大型前瞻性研究以进一步调查这些关系。
