Gender Disparities in Vascular Access and One-Year Mortality among Incident Hemodialysis Patients: An Epidemiological Study in Lazio Region, Italy

(1) Background: Interest in gender disparities in epidemiology, clinical features, prognosis and health care in chronic kidney disease patients is increasing. Aims of the study were to evaluate the association between gender and vascular access (arteriovenous fistula (AVF) or central venous catheter...

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Autores principales:	Laura Angelici, Claudia Marino, Ilaria Umbro, Maurizio Bossola, Enrico Calandrini, Luigi Tazza, Nera Agabiti, Marina Davoli, on behalf of the Regional Registry Dialysis and Transplant Lazio Region
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	AVF catheters dialysis gender mortality vascular access Medicine R
Acceso en línea:	https://doaj.org/article/d738d52cd19b4ac19fd69e4c6eda6e1c
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spelling	oai:doaj.org-article:d738d52cd19b4ac19fd69e4c6eda6e1c2021-11-11T17:44:19ZGender Disparities in Vascular Access and One-Year Mortality among Incident Hemodialysis Patients: An Epidemiological Study in Lazio Region, Italy10.3390/jcm102151162077-0383https://doaj.org/article/d738d52cd19b4ac19fd69e4c6eda6e1c2021-10-01T00:00:00Zhttps://www.mdpi.com/2077-0383/10/21/5116https://doaj.org/toc/2077-0383(1) Background: Interest in gender disparities in epidemiology, clinical features, prognosis and health care in chronic kidney disease patients is increasing. Aims of the study were to evaluate the association between gender and vascular access (arteriovenous fistula (AVF) or central venous catheter (CVC)) used at the start of hemodialysis (HD) and to investigate the association between gender and 1-year mortality. (2) Methods: The study includes 9068 adult chronic HD patients (64.7% males) registered in the Lazio Regional Dialysis Register (January 2008–December 2018). Multivariable logistic regression models were used to investigate the associations between gender and type of vascular access (AVF vs. CVC) and between gender and 1-year mortality. Interactions between gender and socio-demographic and clinical variables were tested adding the interaction terms in the final model. (3) Results: Females were older, had lower educational level and lower rate of self-sufficiency compared to males. Overall, CVC was used in 51.2% of patients. Females were less likely to use AVF for HD initiation than males. 1354 out of 8215 (16.5%) individuals died at the end of the follow-up period. Interaction term between gender and vascular access was significant in the adjusted model. From stratified analyses by vascular access, OR female vs. male (AVF) = 0.65; 95% CI 0.48–0.87 and OR female vs. male (CVC) = 0.88; 95% CI 0.75–1.04 were found. (4) Conclusions: This prospective population-based cohort study in a large Italian Region showed that in females starting chronic HD AVF was less common respect to men. The better 1-year survival of females is more evident among those women with AVF. Reducing gender disparity in access to AVF represents a key point in the management of HD patients.Laura AngeliciClaudia MarinoIlaria UmbroMaurizio BossolaEnrico CalandriniLuigi TazzaNera AgabitiMarina Davolion behalf of the Regional Registry Dialysis and Transplant Lazio RegionMDPI AGarticleAVFcathetersdialysisgendermortalityvascular accessMedicineRENJournal of Clinical Medicine, Vol 10, Iss 5116, p 5116 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	AVF catheters dialysis gender mortality vascular access Medicine R
spellingShingle	AVF catheters dialysis gender mortality vascular access Medicine R Laura Angelici Claudia Marino Ilaria Umbro Maurizio Bossola Enrico Calandrini Luigi Tazza Nera Agabiti Marina Davoli on behalf of the Regional Registry Dialysis and Transplant Lazio Region Gender Disparities in Vascular Access and One-Year Mortality among Incident Hemodialysis Patients: An Epidemiological Study in Lazio Region, Italy
description	(1) Background: Interest in gender disparities in epidemiology, clinical features, prognosis and health care in chronic kidney disease patients is increasing. Aims of the study were to evaluate the association between gender and vascular access (arteriovenous fistula (AVF) or central venous catheter (CVC)) used at the start of hemodialysis (HD) and to investigate the association between gender and 1-year mortality. (2) Methods: The study includes 9068 adult chronic HD patients (64.7% males) registered in the Lazio Regional Dialysis Register (January 2008–December 2018). Multivariable logistic regression models were used to investigate the associations between gender and type of vascular access (AVF vs. CVC) and between gender and 1-year mortality. Interactions between gender and socio-demographic and clinical variables were tested adding the interaction terms in the final model. (3) Results: Females were older, had lower educational level and lower rate of self-sufficiency compared to males. Overall, CVC was used in 51.2% of patients. Females were less likely to use AVF for HD initiation than males. 1354 out of 8215 (16.5%) individuals died at the end of the follow-up period. Interaction term between gender and vascular access was significant in the adjusted model. From stratified analyses by vascular access, OR female vs. male (AVF) = 0.65; 95% CI 0.48–0.87 and OR female vs. male (CVC) = 0.88; 95% CI 0.75–1.04 were found. (4) Conclusions: This prospective population-based cohort study in a large Italian Region showed that in females starting chronic HD AVF was less common respect to men. The better 1-year survival of females is more evident among those women with AVF. Reducing gender disparity in access to AVF represents a key point in the management of HD patients.
format	article
author	Laura Angelici Claudia Marino Ilaria Umbro Maurizio Bossola Enrico Calandrini Luigi Tazza Nera Agabiti Marina Davoli on behalf of the Regional Registry Dialysis and Transplant Lazio Region
author_facet	Laura Angelici Claudia Marino Ilaria Umbro Maurizio Bossola Enrico Calandrini Luigi Tazza Nera Agabiti Marina Davoli on behalf of the Regional Registry Dialysis and Transplant Lazio Region
author_sort	Laura Angelici
title	Gender Disparities in Vascular Access and One-Year Mortality among Incident Hemodialysis Patients: An Epidemiological Study in Lazio Region, Italy
title_short	Gender Disparities in Vascular Access and One-Year Mortality among Incident Hemodialysis Patients: An Epidemiological Study in Lazio Region, Italy
title_full	Gender Disparities in Vascular Access and One-Year Mortality among Incident Hemodialysis Patients: An Epidemiological Study in Lazio Region, Italy
title_fullStr	Gender Disparities in Vascular Access and One-Year Mortality among Incident Hemodialysis Patients: An Epidemiological Study in Lazio Region, Italy
title_full_unstemmed	Gender Disparities in Vascular Access and One-Year Mortality among Incident Hemodialysis Patients: An Epidemiological Study in Lazio Region, Italy
title_sort	gender disparities in vascular access and one-year mortality among incident hemodialysis patients: an epidemiological study in lazio region, italy
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/d738d52cd19b4ac19fd69e4c6eda6e1c
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Gender Disparities in Vascular Access and One-Year Mortality among Incident Hemodialysis Patients: An Epidemiological Study in Lazio Region, Italy

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