Sex disparities and hemodialysis access outcomes
OA Version
Citation
Abstract
OBJECTIVE: Female sex is associated with worse healthcare outcomes. Given that the prevalence and incidence of End-Stage Renal disease (ESRD) is rising, we aimed to assess the association with female sex and hemodialysis access outcomes.
METHODS: A single-center, retrospective review and analysis was conducted of patients from Boston Medical Center (BMC) who went through a first-time arteriovenous fistula (AVF) or arteriovenous prosthetic graft (AVG) creation from 2014 to 2021. Data collection on demographics, comorbidities, socioeconomic status, preprocedural details, procedural variables, and outcomes measures was performed through electronic medical record review.
RESULTS: Of the 595 subjects who underwent a first time AV access creation, 41.5% were female and 58.5% were male. The mean age across both sexes was 59.6, with female average age 61.5 ± 14.56 and male average age 58.2 ± 13.37. Male patients were more likely to be employed (16.67% vs 9.78%; P = 0.021), and retired patients were more likely to be female (34.55% vs 43.11%; P = 0.041). Multivariable logistic regression analysis revealed that males had lower odds of their AVF access failing to mature as compared to females (OR: 0.56, 95% CI 0.34- 0.84). Males with a newly created AVF were 40% more likely to undergo any reintervention (OR: 1.43, 95% CI: 0.10-2.06). Sex was not significantly associated with likelihood of abandonment of an AVF, readmission within 30 days, or mortality over the course of the study (P > 0.05). Being employed was associated with a 50% lower odds of mortality (OR: 0.50, 95% CI: 0.26-0.96, P = 0.036). Cox regression analysis showed there were differences between males and females in freedom from any reintervention and freedom from new access creation/abandonment (P > 0.05). Kaplan Meier survival curves revealed that if a patient required an reintervention after 200 days, females would not undergo additional procedures as frequently as males. Female patients were less likely to abandon their access if their access survived beyond 200 days, while male patients were still at risk of abandoning their access throughout the first two years after access creation (P > 0.05). Patient sex did not significantly influence overall survival after AVF/AVG creation (P > 0.05) during the first two years of new access creation.
CONCLUSIONS: Female sex is associated with worse AVF maturation rates and increased risk of new access creation or abandonment. Male sex is associated with increased risk for reinterventions. Further research on socioeconomic disadvantages and differences in aging between sexes may help to explain these discrepancies.
Description
2024