Care trajectory differences in women and men with end-stage renal disease after dialysis initiation

INTRODUCTION: End-Stage Kidney Disease (ESKD) is a major public health issue with an important burden for patients. Some sex and gender differences related to ESKD are well documented. For example, more men initiate dialysis. However, less is known about the differences in the care that follows dialysis start. The objective of this study was to describe the differences in healthcare utilization in the year following dialysis initiation between men and women. METHODS: Data from the French National Renal Epidemiology and Information Network (REIN) registry linked with the French National Health Data System (SNDS) were used. All adults patients with ESKD who initiated dialysis in France in 2015 were included. Characteristics at dialysis start, including co-morbidities, were compared between men and women. The healthcare utilization, outpatient and inpatient, in the year following dialysis start was examined as frequencies and compared by sex using Chi-2 and Student or Welch test. RESULTS: We included 8856 patients (36% of women). Women had fewer hospital stays <24 hours than men (53% with > =1 hospitalization <24 hours vs 57% among men, p-value=0.02) and fewer hospital stays for other problems than renal (44% had >2 hospital stays vs 46% in men, p-value=0.04). Hospital stays for vascular access preparation or maintenance were longer in women than men (median duration: 2 days vs 1 day, p-value<0.001). No significant difference was observed between women and men about hospital stays for kidney problems and consultations with a general practitioner. CONCLUSIONS: Taking advantage of the linkage of national clinical and healthcare utilization databases, this study shed light on the care trajectory that follows dialysis initiation between men and women. Similarities were observed, including outpatient follow-up with a GP. Some specific differences, such as longer hospital stays for vascular access preparation or maintenance, calls for further studies to improve the care of women with ESKD. KEY MESSAGES: • Few differences exist between men and women in their care trajectory notably an outpatient follow-up with a GP. • Some differences have been highlighted, especially in some hospital stay duration that could be a subject of futures studies.