Prescribing hemodialysis: the role of gender

Mortality rates remain high in the United States for people who depend on artificial kidney replacement for their existence, and the mortality rates are similar in men and women. However, women differ from men in many respects; some of these ways may have an impact on the response to dialysis through mechanisms that need to be further explored. Observational studies have shown that women respond more readily to a higher dose of dialysis, and recent data from the HEMO clinical trial suggest that women respond to an increase in clearance of low-molecular-weight uremic toxins, whereas men do not. If the findings of these studies prove to be accurate, then we may conclude not only that women require a higher dose of dialysis as currently measured, but we might also expect women to require dialysis sooner during the course of a progressive decline in renal function. The reason for this gender-dependent difference in susceptibility escapes definition at the present time, but size is an obvious confound that can be explored by using current data and in future studies. More detailed analyses of the HEMO data are forthcoming and may shed further light on this question.