Study Examines Sex-Specific Disparity in Replacement Therapy for Kidney Disease


More men than women initiate kidney replacement therapy despite a higher prevalence of chronic kidney disease seen in women.

Although more men than women undergo kidney replacement therapy (KRT), a larger number of women are affected by chronic kidney disease (CKD).

A new study published in the Clinical Journal of American Society of Nephrology looked at sex differences in KRT initiation and maintenance to identify historic and geographic trends in sex-specific incidence and prevalence of various KRT modalities.

According to available data on CKD, women tend to experience a higher prevalence, but men are more likely to suffer kidney failure as assessed by rates of initiation of KRT, highlighting a contrast between higher morbidity in women and higher mortality in men.

Using data from the European Renal Association-European Dialysis and Transplant Association Registry from 1965 to 2015, the researchers assessed sex-specific differences in KRT incidence and prevalence. They analyzed data from 230,378 patients receiving KRT, 38% of whom were women.

For all KRT modalities, the incidence and prevalence rates were consistently higher in men than women, according to the results. The primary treatment modality of choice remained relatively stable, with hemodialysis being the most commonly used modality throughout the study period in all age groups.

The data showed that the overall incidence rate of KRT increased from 10 per million population (pmp) from 1965-1974 to 135 pmp from 2005-2015. Although the incidence of KRT in women increased 8 to 98 pmp over the same time periods, the percentage of women commencing KRT remained stable over time and was consistently lower than that of men at 37% to 42%, even across all age strata, according to the study.

Additionally, the researchers also found that male-to-female ratios for incident KRT increased with age, showing consistency over decades. Furthermore, diabetes as an underlying kidney disease was associated with a lower rate of pre-emptive kidney transplantation in women than in men, especially among elderly patients, according to a stratified analysis of patients with diabetes.

The researchers noted potential explanations for the discrepancy, such as unequal access to KRT, competing risks of dying before KRT initiation, and faster progression of CKD in men than women.

“Future epidemiologic studies should address sex-specific KRT initiation by primary kidney disease, and evaluate potential sex differences in the competing risks of mortality versus KRT initiation in the general population,” the researchers wrote in the study.


Antlanger M, Noordzij M, van de Luijtgaarden, et al. Sex differences in kidney replacement therapy initiation and maintenance. Clinical Journal of American Society of Nephrology. 2019. Doi:

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