Gender Disparity in Hemodialysis Practices and Mortality: A Nationwide Cross-Sectional Observational Study

Disparities between genders are well documented in incidence, progression, and outcomes of chronic kidney disease (CKD). This study aimed to describe demographic characteristics, clinical and socio-economic factors among males and females on maintenance hemodialysis and to determine any association with mortality among males and females.

A nationwide cross-sectional study was conducted in a hemodialysis network in India. All adult (>18 years) patients who died while receiving maintenance hemodialysis and an equal number of surviving control patients on maintenance hemodialysis (MHD) between January 1, 2021 to March 31, 2021 were included in the study. The demographic, socioeconomic, and hemodialysis factors were compared between both the genders.

A total of 1177 patients who died during the study period were included. The majority were males (824, 70.01%). Males were more educated than females (P < 0.001). The proportion of female patients dialysed with temporary catheters where more than males, who had definite vascular access such as AV fistula or AV graft (P < 0.001). More female patients required out-of-pocket expenditure (P = 0.005). Multivariate logistic regression demonstrated that lower educational status, hypoalbuminemia, previous history of hospitalization, and dialysis in centres run by Public Private Partnership (PPP) were associated with mortality in males. Lower educational status, heart failure and previous history of hospitalization were the factors associated with mortality in females.

Males predominated on hemodialysis. Females were less educated and were less likely to be covered under public or private health insurance compared to males.