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Peritoneal dialysis (PD) has many advantages as a home treatment. While sex differences exist in the diagnosis and management of numerous different diseases, including kidney disease, there is a limited understanding of whether sex influences PD outcomes. Using the prospective worldwide Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS), we have been able to describe some initial significant sex disparities in several important PD outcomes.
Data from 8 countries [Australia and New Zealand (A/NZ), Canada, Japan, Thailand, South Korea, United Kingdom, United States (US)] participating in PDOPPS (2014-2022) were used to examine the association of sex (male vs female; assumed to be biological sex at birth) with various outcomes shown, with adjustments for numerous potential confounders, among PD patients ≥18 yrs old.
In prevalent cross-sections, women comprised 43% of PD patients overall ranging from 33% in Japan to 51% in Thailand. The mean ages of women were 2-5 yrs younger than those of men in all countries except for Japan and Thailand where women were older by a mean age of 1 year. Women were less likely to have diabetes and coronary artery disease in all countries except Thailand where a PD-first policy was in place. The proportion of women in our PDOPPS sample was nearly identical to a contemporaneous sample of five national registries (A/NZ, Canada, Japan, UK, US) When compared to women, men had higher adjusted hazard ratios (AHR) for death [AHR=1.20 (1.04-1.39)], permanent transfer to HD [AHR=1.23 (1.10-1.38)], and peritonitis [AHR=1.13 (1.02-1.24], and poorer kidney disease burden scores, but had higher physical component summary (PCS) QOL scores and lower adjusted odds of having drain pain [AOR=0.61 (0.48-0.78)].
Findings from PDOPPS highlight some substantial sex differences in key PD patient outcomes highlighting the need to better understand the reasons for these differences. Future work will characterize sex disparities in PDOPPS including PD practices in an effort to identify sex-specific considerations that can be applied for improving global outcomes for both women and men receiving PD.