Sex disparity and the uptake of home dialysis following kidney transplant failure.

Abstract

Introduction: Home dialysis modalities offer several clinical and economic benefits, as well as superior patient autonomy compared to facilitybased dialysis treatment in patients with kidney failure. In patients with failing kidney allografts, adequate preparation for dialysis, especially home dialysis treatments may not be the focus of care for clinicians, as strategies to maintain sufficient allograft function to avoid dialysis is often the clinical priority. Studies have demonstrated that sex and socioeconomic status (SES) disparities exist in the access to dialysis and transplantation in patients with kidney failure, but whether a similar disparity occurs in the access to home dialysis after kidney transplant failure is unknown. Method(s): Using data from ANZDATA registry, the associations between sex and uptake of peritoneal (PD) and home haemodialysis (HHD) at 12-months after kidney transplant failure in Australia (2000-2020) were examined using adjusted logistic regression, including for possible sex by SES (socio-economic advantaged vs. disadvantaged status) interactions. Result(s): Of 3521 patients who experienced first kidney transplant failure, 1352 (38%) were females. At 12-months following kidney transplant failure, 483 (14%) were maintained on PD, 425 (12%) maintained on HHD, 1803 (51%) maintained on facility-based HD, and 810 (23%) did not reach the 12-month follow-up period, died, or had received a second kidney transplant. Compared to female patients, male patients were less likely to be maintained on PD at 12-months after kidney transplant failure, with adjusted OR (95%CI) of 0.55 (0.44, 0.68). The adjusted OR (95%CI) for the uptake of HHD at 12-months after kidney transplant failure in male patients was 1.66 (1.29, 2.12). There were significant interactions between sex and SES for the 12-month uptake of PD and HHD (p-values for interactions <0.01), such that patients from the socio-economic disadvantaged group, the respective adjusted OR for the uptake of PD and HHD in male patients were 0.61 (0.45, 0.84) and 2.25 (1.51, 3.51) compared to female patients. For patients from the socio-economic advantaged group, the respective adjusted OR for the uptake of PD and HHD for male patients were 0.50 (0.38, 0.67) and 1.34 (0.98, 1.85). Conclusion(s): Sex disparity in the uptake of home dialysis treatment is evident after kidney transplant failure, with male patients more likely to prefer HHD over PD compared to female patients. This sex disparity was more apparent in patients from more socio-economic disadvantaged areas. Future studies are required to establish the explanation of this observed difference.