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      Sex-related differences in pre-dialysis trajectories and dialysis initiation: A French nationwide retrospective study

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          Abstract

          Background

          In the last two decades, sex and gender differences have been documented in chronic kidney disease (CKD) management, including access to renal replacement therapy and its outcomes. The objectives of this study were to 1) compare the pre-dialysis healthcare utilization in men and women, and 2) examine the sex-specific factors associated with emergency dialysis start.

          Methods

          Adult patients with CKD who started dialysis in France in 2015 were extracted from the Renal Epidemiology and Information Network registry. Patients were matched to the French National Health Data System database to extract healthcare utilization data for the 2 years before dialysis start. Frequencies and monthly rates of consultations and hospitalizations were compared between men and women. Logistic regression analyses were performed separately in the two groups.

          Results

          Among the 8856 patients included, 3161 (35.7%) were women. Median age (71 years) and estimated glomerular filtration rate (8.1 and 7.7 ml/min for men and women) were similar between groups at dialysis start. Monthly consultations rates with a general practitioner and nephrology-related care were similar between women and men. Some sex-specific differences were found: higher frequencies of consultations with a psychiatrist in women and more frequent hospitalizations for circulatory system diseases in men. Emergency dialysis start rate was 30% in both groups. Emergency dialysis start was associated with acute nephropathy, compared with slowly progressive nephropathy, in women but not in men (OR = 1.48, p<0.01 vs 1.15, p = 0.18).

          Conclusions

          This study found similar quantitative pre-dialysis healthcare utilization in men and women. To better understand sex/gender differences in CKD care trajectories, future research should focus on patients with CKD who are unknown to nephrology services, on patients receiving conservative care and on the sex/gender-specific mechanisms underlying care decision-making.

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          Most cited references57

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          Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls

          Jonathan Sterne, Ian R White, John B Carlin … (2009)
          Most studies have some missing data. Jonathan Sterne and colleagues describe the appropriate use and reporting of the multiple imputation approach to dealing with them
          Article 0 comments Cited 1466 times – based on 0 reviews     Review now
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            Sex and gender: modifiers of health, disease, and medicine

            Franck Mauvais-Jarvis, Noel C Bairey Merz, Peter Barnes … (2020)
            Summary Clinicians can encounter sex and gender disparities in diagnostic and therapeutic responses. These disparities are noted in epidemiology, pathophysiology, clinical manifestations, disease progression, and response to treatment. This Review discusses the fundamental influences of sex and gender as modifiers of the major causes of death and morbidity. We articulate how the genetic, epigenetic, and hormonal influences of biological sex influence physiology and disease, and how the social constructs of gender affect the behaviour of the community, clinicians, and patients in the health-care system and interact with pathobiology. We aim to guide clinicians and researchers to consider sex and gender in their approach to diagnosis, prevention, and treatment of diseases as a necessary and fundamental step towards precision medicine, which will benefit men's and women's health.
            Article 0 comments Cited 687 times – based on 0 reviews     Review now
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              Gender differences in the utilization of health care services.

              K D Bertakis, R Azari, L J Helms … (2000)
              Studies have shown that women use more health care services than men. We used important independent variables, such as patient sociodemographics and health status, to investigate gender differences in the use and costs of these services. New adult patients (N = 509) were randomly assigned to primary care physicians at a university medical center. Their use of health care services and associated charges were monitored for 1 year of care. Self-reported health status was measured using the Medical Outcomes Study Short Form-36 (SF-36). We controlled for health status, sociodemographic information, and primary care physician specialty in the statistical analyses. Women had significantly lower self-reported health status and lower mean education and income than men. Women had a significantly higher mean number of visits to their primary care clinic and diagnostic services than men. Mean charges for primary care, specialty care, emergency treatment, diagnostic services, and annual total charges were all significantly higher for women than men; however, there were no differences for mean hospitalizations or hospital charges. After controlling for health status, sociodemographics, and clinic assignment, women still had higher medical charges for all categories of charges except hospitalizations. Women have higher medical care service utilization and higher associated charges than men. Although the appropriateness of these differences was not determined, these findings have implications for health care.
              Article 0 comments Cited 431 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Maxime Raffray:
                ORCID: https://orcid.org/0000-0002-1482-6298
                Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: VisualizationRole: Writing – original draft
                Louise Bourasseau: Role: Formal analysisRole: InvestigationRole: Writing – original draft
                Cécile Vigneau: Role: ConceptualizationRole: MethodologyRole: SupervisionRole: ValidationRole: Writing – review & editing
                Cécile Couchoud: Role: Data curationRole: MethodologyRole: ValidationRole: Writing – review & editing
                Clémence Béchade: Role: ValidationRole: Writing – review & editing
                François Glowacki: Role: ValidationRole: Writing – review & editing
                Sahar Bayat: Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: Project administrationRole: SupervisionRole: ValidationRole: Writing – review & editing
                Chikezie Hart Onwukwe: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS One
                Journal ID (publisher-id): plos
                Title: PLOS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 27 March 2024
                Publication date Collection: 2024
                Volume: 19
                Issue: 3
                Electronic Location Identifier: e0299601
                Affiliations
                [1 ] Univ Rennes, EHESP, CNRS, Inserm, Arènes—UMR 6051, RSMS (Recherche sur les Services et Management en Santé), Rennes, France
                [2 ] Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail), Rennes, France
                [3 ] Renal Epidemiology and Information Network (REIN) Registry, Biomedicine Agency, Saint-Denis-La-Plaine, France
                [4 ] Néphrologie, CHU Clemenceau, Caen, France
                [5 ] Service de néphrologie, Hôpital Huriez, CHRU de Lille, Lille, France
                Isawiya General Hospital, Governorate of Gurayyat, SAUDI ARABIA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                ¶ Membership of the REIN registry is provided in the Acknowledgments.

                Author information
                https://orcid.org/0000-0002-1482-6298
                Article
                Publisher ID: PONE-D-23-33969
                DOI: 10.1371/journal.pone.0299601
                PMC ID: 10971748
                PubMed ID: 38536864
                SO-VID: 8842385a-8055-472e-9777-1bd25c02b8ed
                Copyright © © 2024 Raffray et al
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 24 November 2023
                Date accepted : 13 February 2024
                Page count
                Figures: 4, Tables: 4, Pages: 18
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100007525, Université de Rennes 1;
                Award Recipient :
                ORCID: https://orcid.org/0000-0002-1482-6298
                This research was funded by a PhD grant from University of Rennes 1, France. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Subject: Research Article
                Subject: Medicine and Health Sciences
                Subject: Nephrology
                Subject: Medical Dialysis
                Subject: Medicine and Health Sciences
                Subject: Nephrology
                Subject: Renal Diseases
                Subject: Chronic Kidney Disease
                Subject: Medicine and Health Sciences
                Subject: Nephrology
                Subject: Medicine and Health Sciences
                Subject: Health Care
                Subject: Health Care Facilities
                Subject: Hospitals
                Subject: Hospitalizations
                Subject: Medicine and Health Sciences
                Subject: Women's Health
                Subject: People and places
                Subject: Geographical locations
                Subject: Europe
                Subject: European Union
                Subject: France
                Subject: Medicine and Health Sciences
                Subject: Ophthalmology
                Subject: Medicine and Health Sciences
                Subject: Medical Conditions
                Subject: Cardiovascular Diseases
                Subject: Cardiovascular Diseases in Women
                Subject: Medicine and Health Sciences
                Subject: Cardiology
                Subject: Cardiovascular Medicine
                Subject: Cardiovascular Diseases
                Subject: Cardiovascular Diseases in Women
                Subject: Medicine and Health Sciences
                Subject: Women's Health
                Subject: Cardiovascular Diseases in Women
                Custom metadata
                Data Availability The data used in the study cannot be shared publicly because it comprises of healthcare use at the individual level of French citizen (SNDS database). Data from the SNDS are available from the French Health Data Hub ( https://smex-ctp.trendmicro.com:443/wis/clicktime/v1/query?url=https%3a%2f%2fwww.health%2ddata%2dhub.fr%2fdepot&umid=cbfb002f-8daa-401b-b5fe-59ff4db6872a&auth=cb5fd73bba5cd044cb5e5d90152ce147860ea990-d41f3f7e4e4e3a1074ee8ec2f11c75ea6e0d08ca) for researchers who meet the criteria for access to confidential data. The process will require authorization from the French Data Protection Authority (Commission nationale de l’informatique et des libertés). For this particular study, access was granted by the French Data Protection Authority (Commission nationale de l’informatique et des libertés, CNIL authorization N° 917021). Additionally, the REIN registry data was linked with the SNDS data with the approuval of the relevant French committees, the Comité consultatif sur le traitement de l’information en matière de recherche (CCTIRS) and the French Data Protection Authority (Commission nationale de l’informatique et des libertés) (CNIL N° 903188). Information about the data of the REIN registry can be requested by mail to Dr. Cécile Couchoud who coordinates the REIN registry at the French Biomedicine Agency ( cecile.couchoud@ 123456biomedecine.fr ). We have joined the authorizations cited during the submission process.

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                Data availability:
                ScienceOpen disciplines: Uncategorized

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