Introduction:
Global data indicates that men are more likely to initiate dialysis or undergo transplants despite the higher prevalence of chronic kidney disease (CKD) among women. This disparity is attributed to biological differences, cultural pressures, and the accelerated progression of CKD in men. Financial constraints, limited social security, and patriarchal structures further restrict women's autonomy in making treatment decisions. Women on dialysis face not only limited access to treatment but also gender-specific challenges. Our study aims to explore the gender-specific prevalence rates of dialysis in Kerala and investigate the subjective experiences, perceptions, gender-specific pressures, and quality of life (QOL) of females on hemodialysis compared to their male counterparts.
Methods:
The study was conducted from April 2024 to July 2024 in 4 districts of Kerala. We analysed the female-to-male prevalence ratio of dialysis patients using data from 11 dialysis units. Additionally, structured interviews were conducted with all female patients on dialysis who gives consent and equal number of randomly selected male patients from each dialysis units to examine the gender-specific issues faced by female patients and compare their quality of life (QOL) with that of male patients. The EQ-5D-5L questionnaire was used to assess QOL.
Results:
A total of 1156 patients were undergoing regular dialysis in 11 dialysis units which participated for the study, of whom only 30.2% were females. From this group, 533 patients participated in the survey: 257 females (48.2%) and 276 males (51.8%), with a mean age of 61 ±10.3 for females and 61 ±11.3 years for males. Diabetic nephropathy was identified as the primary cause of CKD in both genders, affecting 171 females (66.6%) and 177 males (64.1%). Significant differences in hemodialysis access were observed: 65 (25.8%) of females used catheters compared to 35 (12.6%) of males (P < 0.001). Most females (62%) reported experiencing gender-specific pressures during treatment. Additionally, females had significantly lower quality of life scores (0.639 ± 0.34) compared to males (0.717 ± 0.31), (P < 0.001).
Conclusions:
The study reveals a lower prevalence of females on dialysis, largely due to reduced access and care. A significant majority of female patients did not receive access to fistula creation, relying instead on catheters. Most females face gender-specific pressures from family or society during treatment. Consequently, females reported significantly lower quality of life scores compared to males. The nephrology community should prioritize improving access to dialysis and fistula creation for female patients. Additionally, there should be initiatives to address and mitigate gender-specific pressures to enhance the overall quality of life for female dialysis patients.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.