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Although women exhibit a greater incidence of chronic kidney disease, more men initiate kidney replacement therapy (KRT). The aim of this study is
1. To describe demographic characteristics, hemodialysis (HD), clinical and socio-economic factors among males and females on hemodialysis.
2. To determine any association between risk factors and mortality among males and females
A nationwide prospective observational study was conducted in India. All adult (>18 years) patients receiving maintenance hemodialysis (HD) in 234 HD centres for a minimum period of 90 days were included in the study. Data was recorded from January 2021 to March 2021. The demographic, clinical, laboratory and survival data was recorded.
Characteristics
Males (N-824)
Females (N-353)
p-value
Demographic factors
Age (years)
55.16 ± 13.2
55.14 ± 13.3
0.981
Education
Illiterate
215 (26.1%)
136 (38.5%)
0.00
High school
230 (27.9%)
113 (32.0%)
Higher Secondary
161 (19.5%)
44 (12.5%)
College
218 (26.5%)
60 (17.0%)
BMI (Indian)
22.55 ± 4.2
22.82 ± 5.5
0.364
Zone
North
173 (21.0%)
94 (26.6%)
0.092
East
122 (14.8%)
45 (12.7%)
West
126 (15.3%)
61 (17.3%)
South
403 (48.9%)
153 (43.3%)
Dialysis factors
HD duration (months)
22.72 ± 17.0
24.75 ± 17.8
0.065
HD frequency (per week)
0.094
1X
15 (1.8%)
8 (2.3%)
2X
434 (52.7%)
186 (52.7%)
3X
366 (44.4%)
156 (44.2%)
Irregular/SOS
9 (1.1%)
3 (0.8%)
Vascular access
AVF/AVG
718 (87.1%)
278 (78.8%)
Catheter
106 (12.9%)
75 (21.2%)
Dialysis adequacy
1.26 ± 0.1
1.25 ± 0.1
0.338
Clinical factors
Hb Level g/dl (1176)
9.12 ± 1.6
8.95 ± 1.4
0.090
Serum Albumin g/dl
3.53 ± 0.5
3.54 ± 0.5
0.860
EPO use
Yes
786 (95.4%)
342 (96.9%)
0.239
No
38 (4.6%)
11 (3.1%)
Cause of CKD
Non-Diabetic
552 (67.0%)
212 (60.1%)
0.022
Diabetic
272 (33.0%)
141 (39.9%)
HTN
Systolic blood pressure
153 ± 23.2
148 ± 23.7
0.002
Diastolic blood pressure
83 ± 11.5
81 ± 11.9
0.027
History of Heart Failure
61 (7.4%)
16 (4.5%)
0.068
763 (92.6%)
337 (95.5%)
History of ischaemic heart disease
68 (8.3%)
12 (3.4%)
756 (91.7%)
341 (96.6%)
Hospitalization in previous 3 months
186 (22.6%)
87 (24.6%)
0.440
638 (77.4%)
266 (75.4%)
Outcome
Survivors
433 (52.5%)
190 (53.8%)
0.688
Non-survivors
391 (47.5%)
163 (46.2%)
Socio-economic factors
Payer type
Out of pocket
224 (27.2%)
121(34.3%)
0.013
Private Insurance
257 (31.2%)
104 (29.5%)
Public Insurance
337 (40.9%)
121 (34.3%)
Mixed
6 (0.7%)
7 (2.0%)
Type of centre
Public-private
371(45.0%)
128 (36.3%)
0.005
Private hospital-based
453(55.0%)
225 (63.7%)
A total of 1177 patients were included in the study. Majority (824)70.01% were males and (353) 29.99% were females. Mean age was 55.16 ± 13.2 years in males and 55.14 ± 13.3 years in females. Males were more educated than females (P= 0.00). Females received lesser number of HD sessions per week (P=0.09) and had lesser hemoglobin levels compared to males (P=0.09). Female patients were predominantly on temporary catheters compared to males, who had a definite vascular access such as AV fistula or AV graft (P=0.00). Out-of-pocket expenditure was more for females compared to males (P=0.005). HTN and ischemic heart disease were significantly more prevalent in males (P=0.02), while diabetes as the cause of ESKD was more prevalent in females (P=0.022). However, there was no difference in BMI (P=0.36), dialysis adequacy (P=0.33), EPO use (P=0.239), hospitalization rates (P=0.44) and survival (P=0.68) in both groups.
Males
Risk ratio (95% CI)
Females
Age
18 - 40
Ref
41 - 60
1.11 (.886, 1.403)
0.352
.838 (.608, 1.157)
0.285
61 - 80
1.04 (.820, 1.335)
0.713
.958 (.695, 1.320)
0.796
>80
1.46 (.941, 2.280)
.653 (.129, 3.312)
0.608
Education status
1.487 (1.187, 1.862)
0.001
1.744 (1.222,2.489)
Conclusions
Though CKD is more common in females, the majority of males received hemodialysis. Females were less educated, received a lesser number of hemodialysis sessions, were on temporary HD catheters and had lesser hemoglobin levels compared to males. There was no significant difference with respect to gender specific risk factors for mortality