Sex-Specific Outcomes in the Peritoneal Dialysis Outcomes and Practice Patterns Study

Area of Science:

• Nephrology
• Clinical Medicine
• Epidemiology

Background:

• Sex differences in peritoneal dialysis (PD) outcomes are not well understood.
• Optimizing PD care requires understanding these sex-based disparities.
• This study investigates the association between sex and PD outcomes.

Purpose of the Study:

• To explore the association of sex with key outcomes in patients undergoing peritoneal dialysis.
• To identify potential sex-specific differences in mortality, dialysis transfer, peritonitis, and transplantation.
• To inform sex-specific strategies for personalized PD management.

Main Methods:

• Analysis of data from the international PD Outcomes and Practice Patterns Study across eight countries.
• Inclusion of 26,292 individuals on PD, with 43% being female.
• Utilized cause-specific Cox regression models to assess sex-associated clinical outcomes, adjusting for various covariates.

Main Results:

• Women had significantly lower adjusted hazard ratios for mortality (0.92), transfer to hemodialysis (0.87), and the composite of both (0.89) compared to men.
• Women also showed a reduced risk of peritonitis (aHR, 0.90), particularly gram-positive peritonitis (aHR, 0.73).
• Transplant hazards were similar between sexes, and diabetes attenuated the survival benefits observed in women.

Conclusions:

• Women receiving PD demonstrate lower risks of mortality, hemodialysis transfer, and peritonitis compared to men.
• Sex differences in PD outcomes were notable in specific regions like South Korea.
• Understanding these sex-based differences is crucial for developing tailored PD management strategies and enhancing personalized care.