Gender Disparities in Vascular Access and One-Year Mortality among Incident Hemodialysis Patients: An Epidemiological Study in Lazio Region, Italy

Journal of Clinical Medicine

on behalf of the Regional Registry Dialysis and Transplant Lazio Region¹  Luigi Tazza²  Enrico Calandrini³  Laura Angelici³  Claudia Marino³  Nera Agabiti³  Marina Davoli³  Ilaria Umbro⁴  Maurizio Bossola⁵ 

[1]

[2]Catholic University, 00168 Rome, Italy

[3]Department of Epidemiology Regional Health Service Lazio, 00147 Rome, Italy

[4]Geramed Dialysis Center, Fiano Romano, 00065 Rome, Italy

[5]Haemodialysis Unit, Department of Medical and Surgical Science, Policlinico Universitario Fondazione Agostino Gemelli, 00168 Rome, Italy

关键词: AVF;    catheters;    dialysis;    gender;    mortality;    vascular access;   

DOI  :  10.3390/jcm10215116

来源: DOAJ

【 摘 要 】

(1) Background: Interest in gender disparities in epidemiology, clinical features, prognosis and health care in chronic kidney disease patients is increasing. Aims of the study were to evaluate the association between gender and vascular access (arteriovenous fistula (AVF) or central venous catheter (CVC)) used at the start of hemodialysis (HD) and to investigate the association between gender and 1-year mortality. (2) Methods: The study includes 9068 adult chronic HD patients (64.7% males) registered in the Lazio Regional Dialysis Register (January 2008–December 2018). Multivariable logistic regression models were used to investigate the associations between gender and type of vascular access (AVF vs. CVC) and between gender and 1-year mortality. Interactions between gender and socio-demographic and clinical variables were tested adding the interaction terms in the final model. (3) Results: Females were older, had lower educational level and lower rate of self-sufficiency compared to males. Overall, CVC was used in 51.2% of patients. Females were less likely to use AVF for HD initiation than males. 1354 out of 8215 (16.5%) individuals died at the end of the follow-up period. Interaction term between gender and vascular access was significant in the adjusted model. From stratified analyses by vascular access, OR female vs. male (AVF) = 0.65; 95% CI 0.48–0.87 and OR female vs. male (CVC) = 0.88; 95% CI 0.75–1.04 were found. (4) Conclusions: This prospective population-based cohort study in a large Italian Region showed that in females starting chronic HD AVF was less common respect to men. The better 1-year survival of females is more evident among those women with AVF. Reducing gender disparity in access to AVF represents a key point in the management of HD patients.

【 授权许可】

Unknown