Sex Differences in Hemodialyzed Patients with End-Stage Kidney Disease—Data from a Large Polish Database

Background: Chronic kidney disease is more prevalent in women, while more men than women start dialysis. Data on the sex differences in dialysis regarding comorbidities, dialysis adequacy, and access to transplantation are limited. Taking all these data into consideration, the aim of our study was to assess sex differences in an unselected large population of hemodialyzed patients in Poland. Methods: In a non-selected population of 5879 hemodialyzed patients (mean age 65.2 ± 14.2 years, 60% of males receiving hemodialysis), we assessed BMI (body mass index), comorbidities, status on transplantation list, pre-dialysis blood pressure and heart rate, hypertension presence, prevalence of apparent treatment resistant hypertension (aTRH), selected biochemical parameters, and data regarding HD (dialysis vintage, effective weekly dialysis time, eKT/V, ultrafiltration, interdialytic body weight gain unindexed and expressed as the percent of dry body weight in relation to sex). Propensity score matching was performed as an additional method to reduce baseline differences between men and women. Results: In the unselected population, men were younger, with lower BMI, lower prevalence of obesity, higher prevalence of hypertension and aTRH, had higher blood pressure with more hypotensive drugs, were more often dialyzed using arteriovenous fistula, lower dialysis vintage, higher time of dialysis, lower eKT/V, higher ultrafiltration and higher interdialytic body weight gain. After propensity score matching, age was not significantly different was well as prevalence of comorbidities (chronic heart failure, coronary artery disease, peripheral artery disease, cerebrovascular disease, diabetes). However, prevalence of hypertension and aTRH as well as blood pressure values were significantly higher in men over women. In addition, regarding parameters related to the dialysis, men more often had arteriovenous fistula as vascular access, lower dialysis vintage, higher time of dialysis, lower eKT/V and higher ultrafiltration and higher interdialytic body weight gain. Conclusions: Hemodialyzed women and men differed in several demographic, dialysis-related, and biochemical characteristics. Importantly, both sexes had the same access to active waitlisting list for kidney transplantation. These findings suggest that while biological and treatment-related differences between sexes persist in contemporary hemodialysis practice, access to transplantation appears equitable within this population.