Gender Differences in Response to Hemodialysis Treatment: Determinants and Clinical Correlates. Findings from Two Tertiary Health Centers in Southwest Nigeria Gender Differences in Response to Hemodialysis Treatment

Abstract

Background: The physiologic and hormonal differences between males and females could be impactful on dialysis treatment. The differential response is further heightened by differences in socioeconomic, cultural, educational, and genetic makeup.

Aim: We compared the determinants and correlates of the dialysis dose in the two sexes.

Methodology: It was a two-center, hospital-based prospective study in which 1248 dialysis sessions were studied. Participants’ sociodemographics, clinical findings, pre and post-dialysis renal biochemistry and hematocrit results and prescribed dialysis doses were documented and the dialysis dose (urea reduction ratio and urea clearance as a unit of its distribution volume) were calculated.

Results:  Dialysis sessions of 232 participants were studied. The majority (61.6%) were males, but the females were older (50.3 + 9.1yrs versus 48.7 + 6.4yrs. Compared with females, the males had higher educational attainment (P<0.001), more sessions (P=0.002), erythropoietin doses (P<0.001), blood flow rate (P<0.001) and ultrafiltration volume (P=0.003). Intradialytic hypotension (IDH) was more common in females (P<0.001) while intradialytic hypertension (IDHT) was commoner in males (P=0.04). The dialysis dose was higher in men (P=0.02). Dialysis termination was more common with females (P<0.001). The independent predictors of dialysis dose were SPO₂, predialysis albumin and PCV, dialysis duration, blood flow rate and frequency of EPO use. The correlation between Kt/V and URR was very strong (r=0,895, P<0.001).

Conclusion: Males received more dialysis and erythropoietin treatment and had higher dialysis doses.  IDH and dialysis termination were commoner in females while males had more IDHT, higher ultrafiltration volume, more permanent dialysis catheters.  Dialysis formulation should therefore reflect gender disparity in order to address the imbalances.

Keywords: Gender differences, Hemodialysis, urea reduction ratio, intradialytic hypotension, intradialytic hypertension.