Are sex differences in the outcome of peritoneal dialysis explained by nurse-assistance? A cohort study with data from the RDPLF

Assisted peritoneal dialysis in Europe: a strategy to increase and maintain home dialysis

Peritoneal dialysis (PD) is a form of kidney replacement therapy with the major advantage that it can be performed at home. This has a positive impact on patients' autonomy and quality of life. However, the dialysis population is ageing and physical and/or cognitive impairments are common. These limitations often form a barrier to PD and contribute to the low incidence and prevalence of PD in Europe. Assisted PD can be a solution to this problem. Assisted PD refers to a patient being assisted by a person or device in performing all or part of their dialysis-related tasks, thereby making PD more accessible to elderly but also younger frail patients. In this way, offering an assisted PD program can help lower the threshold for initiating PD. In this review, we provide an overview of the epidemiology of assisted PD in Europe, we discuss the different categories and clinical outcomes of assisted PD, and we present how assisted PD can be implemented in clinical practice as a possible strategy to increase and maintain home dialysis in Europe.

Investigation of Factors Affecting Clinical Outcome of Peritoneal Dialysis Patients

Background

End-stage kidney disease (ESKD) is a global issue. Although the use of kidney replacement therapy measures has improved outcomes for patients with ESKD, the mortality rate remains significant. Identifying modifiable factors that affect patient outcomes can help improve their survival. The aim of this study was to investigate the factors affecting the clinical outcome of peritoneal dialysis patients.

Methods

This prospective cohort study was conducted between 2018 and 2021.Participants: Patients aged between 18 and 75 years with a history of peritoneal dialysis (PD) for at least six months were included. Demographic data, kt/v ratio, medical history, serum levels of albumin, creatinine, triglycerides, total cholesterol, calcium, phosphorus, parathyroid hormone, hemoglobin, and ferritin were recorded before starting PD and during the follow-up period, along with clinical outcomes. To describe the data, the central index of mean, frequency, and relative frequency was used, and for analytical statistics, Chi-square test, analysis of variance, and Kruskal-Wallis were used.

Results

A total of 64 patients with a mean age of 51.78 ± 15.31 years were included. Of these, 27 (42.18%) had a history of diabetes mellitus, and 38 (59.37%) had a history of hypertension (HTN). 48 (75%) patients survived until the end of the study, while 47 (73.4%) participants experienced peritonitis. Our findings indicate that variables such as sex, marital status, weight, history of HTN, and serum levels of hemoglobin and ferritin significantly affect outcomes.

Conclusion

We found that factors including sex, marriage, normal weight, HTN, normal hemoglobin, and ferritin can lead to better survival in PD patients. Recurrent peritonitis was the most crucial cause of PD to HD shifts.

Sex disparities in the utilization of nurse-assisted peritoneal dialysis: a mediation analysis using data from the REIN registry

Background

This study was carried out to evaluate the association between patient sex and the proportion of nurse-assisted peritoneal dialysis (PD) at dialysis initiation and to explore whether sex disparities in nurse-assisted PD utilization was explained by predialysis care and/or by social deprivation using mediation analysis.

Methods

This was a retrospective study using data from the Renal Epidemiology and Information Network (REIN) registry linked to the French National Healthcare Database (SNDS) of incident patients between 1 January 2017 and 30 June 2018. A regression logistic was used for statistical analysis. A mediation analysis explored the direct effect of sex on nurse-assisted PD proportion and the indirect effect through the European Deprivation Index (EDI), and the number of general practitioner (GP) and nephrologist visits before dialysis initiation.

Results

Among 1706 patients on PD, there were 637 women (37.3%) and 1069 men (62.7%). Nurse-assisted PD proportion was 332/610 (54.4%) for women vs 464/1036 (44.8%) for men. In the multivariable analysis women were more likely to be treated by nurse-assisted PD {odds ratio (OR) 1.92 [95% confidence interval (CI) 1.46-2.52]}. Nurse-assisted PD was associated with the median number of GP visits [OR 1.44 (95% CI 1.11-1.86)] and with the median number of nephrologist visits [OR 0.59 (95% CI 0.46-0.76)]. The mediation analysis showed a direct effect of sex on nurse-assisted PD [OR 1.90 (95% CI 1.80-2.01)] and an indirect effect through the median number of GP visits [OR 1.05 (95% CI 1.04-1.06], the median number of nephrologist visits [OR 1.02 (95% CI 1.02-1.03)] and quintile 5 of the EDI [OR 1.03 (95% CI 1.02-1.03)].

Conclusion

Women were more frequently treated by nurse-assisted PD than men. Differences between women and men in predialysis care and social deprivation could explain the greater utilization of nurse-assisted PD among women.

Is there sex disparity in vascular access at dialysis initiation in France? A mediation analysis using the data of the REIN registry

Background

This study was conducted to estimate the direct effect of sex on the proportion of hemodialysis catheters at dialysis initiation and to investigate whether predialysis care or socioeconomic status acted as a mediator of the sex effect.

Methods

Patients who started dialysis between 01–01-2017 and 30–06-2018 in France were included using the data of the REIN registry. Logistic regression was performed to study the association between sex and the proportion of HD catheters. A mediation analysis with a counterfactual approach was carried out to evaluate whether there was an indirect effect of gender through the proxies of predialysis care (hemoglobin, albumin levels, glomerular filtration rate (GFR) at dialysis initiation) and socioeconomic status. Due to the identification of an interaction between gender and social deprivation, a subgroup analysis was performed among deprived and nondeprived patients.

Results

There were 16 032 patients included, and the sex ratio (M/F) was 10 405/5627. In the multivariable analysis, women were associated with a greater risk of starting dialysis with a catheter (OR 1.32 [95% CI: 1.23–1.42]). There was an indirect effect of sex on the proportion of HD catheters through proxies for predialysis care (albuminemia < 30 g/L (OR 1.08 [95% CI: 1.05–1.10]), hemoglobin < 11 g/dL (OR 1.03 [95% CI: 1.02–1.04]), GFR < 7 ml/min (OR 1.05 [95% CI: 1.04–1.07])). Among deprived patients, there was no direct effect of sex on the catheter proportion.

Conclusions

Women were associated with a higher risk of starting dialysis through an HD catheter. The effect of sex was mediated by predialysis care, particularly for deprived patients.