GENDER DISPARITY IN MAINTENANCE HEMODIALYSIS UNITS IN PUBLIC SECTOR: OUR EXPERIENCE, FROM LOW -MIDDLE INCOME COUNTRY

Introduction:

Diseases manifest differently according to gender. Though prevalence of Chronic kidney disease is more in women  worldwide, however available literature show more men on kidney replacement therapy.  There are very few studies regarding gender differences in patterns in hemodialysis patients. This study is aimed to assess the gender disparities in maintenance dialysis (MHD) units in public sector with the objectives to analyse  demographic , clinical and socio economic  factors among males and females and to determine their association with mortality.

Methods:

This is an observational study conducted in a public sector teaching hospital, which is the main hub centre with 25 spoke centres assigned under area, local and district hospitals, between May 2024 and July 2024, which included all patients receiving maintenance hemodialysis under this  hub and spoke centre. Patients below 18 years, and those patients with incomplete  data from questionnaire, were excluded. Demographic details, socio-economic data, and laboratory reports were collect from electronic medical records from the system. Structured questionnaire of Kidney disease Quality of Life – 36(KDQOL -36) , was used for assessment of quality of life and their summary scores calculated.The data collected were categorised to male and female and their differences were studied. The various factors influencing mortality and the sex differences associated with them were analysed.

Results:

Of 1241 patients, 69% were men(856) and 31% women(385).Mean age of study population was 49.25 +/- 24.85 years.Majority of the patients had comorbidities of Hypertension (887-71.5%),Diabetes(774-62.4%) and cardiac disease (645-52%).Women group had more comorbid load ,.They were significantly non-compliant to dialysis schedule,with once and twice weekly dialysis and were predominantly on nontunnelled catheters compared to men. With regard to outpatient visits and hospitalization, women significantly stood behind men(p below 0.05).Drop out rate was 2.1% in women and men 0.9% and with significantly higher mortality rate in women(5% vs 3%). Females were illiterate, unemployed,had poor income(p below 0.05) and had higher out of pocket expenses(37.6% vs 35%- p-0.031).On analysis with KDQOL 36 scale, women were found to have significantly low mental (p-0.001)and kidney disease component score(0.041). Comorbid burden of diabetes,cardiac disease, non-compliance to dialysis schedule,lack of proper vascular access were significantly associated with mortality of dialysis women and were found to be elder age group with p-0.05. All the above data are clearly tabulated into 6 tables.

Conclusions:

This study was in line with available literature of Hecking et al and Shankar et al.

·The ratio of women to  men, in maintenance hemodialysis population is approximately 1:2.2, thus predominated by male group.

· Dialysis women, when compared to male counterpart

(1) get initiated  on renal replacement therapy quite late.

(2) are less frequent to dialysis schedules and often noncompliant

(3) lack permanent vascular access

(4) remain socio-economically backward, due to poor educational status, unemployment and are  highly dependent on their attendents.

(5) have less plans of transplant.

(6) have lower quality of life as validated with QOL scales.

(7) are associated to have higher drop out rates as well as mortality

·The major factors influencing mortality of women dialysis patients are elder age, comorbid burden of diabetes and cardiac disease, noncompliance to dialysis and absence of permanent vascular access.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.