#741 Gender differences in vascular access for prevalent dialysis patients
Authors: Roca-Tey Ramon , Comas Jordi , Tort Jaume 
Published: May 2024

Abstract

Background
Gender disparities of some aspects of vascular access (VA) for hemodialysis (HD) have been reported.

Aim
To analyze the VA profile of prevalent HD patients (pts) according to gender in Catalonia

Method
Data from the Catalan Renal Registry of end-stage kidney disease (ESKD) pts over 18 years of age treated by HD on 31 December were examined from 1997 to 2021.

Results
The total cumulative number of follow-ups registered for prevalent ESKD pts treated by HD was 95 575 out of 25 130 pts; we have VA information for most of the follow-ups (93.1%, 88 980/95 575). The number of prevalent HD pts increased from 3104 in 1997 to 4270 in 2021.
The characteristics of prevalent HD pts in 2021 (n = 4270) were different for male (n = 2731) vs female (n = 1539) regarding mean age (69.1 ± 14.6 vs 70.9 ± 14.3 years), age bracket &gt;74 years (42.4% vs 48.3%), median time on HD [24.0 (9.8−48.2) vs 27.6 (10.5−59.1) ], aetiology of ESKD as polycystic kidney disease (4.4% vs 7.2%), normal functional status (38.0% vs 28.4%), cardiovascular disease (76.3% vs 71.1%) and obesity rate (body mass index BMI&gt;30 kg/m2: 17.4% vs 27.2%) (for all comparisons, p &lt; 0.001).
The distribution of the VA used for performing HD in 2021 was also different in men vs women: fistula AVF (58.1%, n = 1465 vs 45.6%, n = 657), graft (1.8%, n = 45 vs 3.5%, n = 51) and tunnelled catheter (35.8%, n = 903 vs 45.8%, n = 660) (for all comparisons, p &lt; 0.001) ; there were no differences for non-tunnelled catheter (4.3%, n = 107 vs 5.0%, n = 72) (p = 0.15). In addition, the type of AVF was different in men vs women: radiocephalic AVF (53.9% vs 40.9%) and brachial artery-based AVF (46.1% vs 59.1%) (p &lt; 0.001).
The percentage of pts who required at least one hospital admission or outpatient procedure for any VA pathology in 2021 was similar when comparing men [7.3% (n = 180) and 19.6% (n = 456), respectively] and women [8.6% (n = 122) and 19.3% (260), respectively] (p = 0.34 and p = 0.38, respectively).
Regarding the total cumulative number of VA used for HD, the percentage of pts who used only one VA was higher for men (50.4%, n = 1265) than women (47.1%, n = 663); however, this difference is reversed when the percentage of pts who used ≥4 VA was calculated: 11.5% (n = 289) vs 14.4% (n = 203) (for all comparisons, p = 0.001). The percentage of pts who have been dialyzed through AVF at some point over time was higher for men (69.2%, n = 1889) than women (62.6%, n = 964) (p &lt; 0.001)
The probability of performing HD through AVF in 2021was independently associated with male gender (odds ratio 1.58 [95% confidence interval: 1.36–1.82], p &lt; 0.001) after adjusting for age, time on HD, primary kidney disease, cardiovascular disease, functional status and BMI (multivariate logistic regression analysis).
The percentage of both men and women on HD through AVF decreased progressively from 1997 (89.1% and 81.3%, respectively) to 2021 (58.1% and 45.6%, respectively) (for both comparisons, p &lt; 0.001). The percentage of prevalent men on HD with AVF was always higher over time than that of women from 1997 (89.1% vs 58.1%) to 2021 (81.3% vs 45.6%) (for both comparisons, p &lt; 0.001).

Conclusions
1) AVF was the main type of VA used for prevalent men on HD, but AVF and tunnelled catheter shared this ranking in women. 2) Male gender was an independent factor associated with a 58% greater probability of performing HD through AVF than female. 3) The percentage of prevalent HD pts dialyzed through AVF progressively decreased over time in both sexes but it was always higher in men than women. 4) The type of AVF mainly used was different depending on gender: radiocephalic AVF for men and brachial artery-based AVF for women.