Sex Differences in Kidney Replacement Therapy Initiation and Maintenance.

Area of Science:

• Nephrology
• Epidemiology
• Public Health

Background:

• Chronic kidney disease (CKD) affects more women than men.
• Kidney replacement therapy (KRT) is more frequently undergone by men.
• Investigating sex-specific trends in KRT is crucial for understanding disparities.

Purpose of the Study:

• To explore historic and geographic trends in sex-specific incidence and prevalence of KRT modalities.
• To compare sex distribution in KRT with the general European population.
• To analyze KRT trends stratified by age and diabetic status.

Main Methods:

• Analysis of multinational European data (1965-2015) from the ERA-EDTA Registry.
• Inclusion of 230,378 patients receiving KRT across nine countries.
• Calculation of sex-specific incidence, prevalence, and male-to-female ratios per million population.

Main Results:

• Men consistently showed higher KRT incidence and prevalence rates than women across all modalities.
• Male-to-female ratios increased with age and remained consistent over decades and countries.
• Kidney transplantation proportion decreased less with age in men than women, particularly in diabetic patients.

Conclusions:

• Fewer women than men have received KRT since the 1960s.
• The male predominance in KRT initiation and prevalence has been consistent over five decades.
• Consistent sex disparities in KRT exist across European countries and over time.