Sex Differences in Kidney Replacement Therapy Initiation and Maintenance

Clin J Am Soc Nephrol. 2019 Nov 7;14(11):1616-1625. doi: 10.2215/CJN.04400419. Epub 2019 Oct 24.


Background and objectives: More men than women undergo kidney replacement therapy (KRT) despite a larger number of women being affected by CKD. The aim of this multinational European study was to explore whether there might be historic and geographic trends in sex-specific incidence and prevalence of various KRT modalities.

Design, setting, participants, & measurements: We assessed sex-specific differences in KRT incidence and prevalence using data from nine countries reporting to the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Registry for at least 40 years, during the period 1965-2015. Sex distribution data were compared with the European general population (Eurostat). Statistical methodology included basic descriptive statistics, incidence and prevalence calculations per million population (pmp), as well as their male-to-female ratios. Analyses were stratified by age group and diabetic status.

Results: We analyzed data from 230,378 patients receiving KRT (38% women). For all KRT modalities, the incidence and prevalence rates were consistently higher in men than women. For example, the KRT incidence increased from 8 pmp in 1965-1974 to 98 pmp in 2005-2015 in women, whereas it rose from 12 to 173 pmp in men during the same period. Male-to-female ratios, calculated for incident and prevalent KRT patients, increased with age (range 1.2-2.4), showing consistency over decades and for individual countries, despite marked changes in primary kidney disease (diabetes more prevalent than glomerulonephritis in recent decades). The proportion of kidney transplants decreased less with age in incident and prevalent men compared with women on KRT. Stratified analysis of patients who were diabetic versus nondiabetic revealed that the male-to-female ratio was markedly higher for kidney transplantation in patients with diabetes.

Conclusions: Since the beginning of KRT programs reporting to the ERA-EDTA Registry since the 1960s, fewer women than men have received KRT. The relative difference between men and women initiating and undergoing KRT has remained consistent over the last five decades and in all studied countries.

Keywords: ESRD; chronic dialysis; chronic hemodialysis; chronic renal insufficiency; clinical epidemiology; diabetic nephropathies; dialysis; edetic acid; epidemiology and outcomes; female; glomerulonephritis; hemodialysis; humans; incidence; kidney transplantation; male; prevalence; registries; renal dialysis; renal replacement; rosa; sex characteristics; sex distribution.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Europe
  • Female
  • Humans
  • Male
  • Middle Aged
  • Renal Replacement Therapy / statistics & numerical data*
  • Sex Distribution
  • Time Factors