Abstract
INTRODUCTION: Previous studies have shown that there is a higher incidence of men initiating kidney replacement therapy (KRT) in comparison to women. However, the contribution of gender disparity may well differ among the different types of kidney disease, and over time. Utilising a Nationwide Registry, we examined disease- and gender-specific trends in incident kidney failure requiring KRT. METHODS: Registry-based analysis of all incident patients commencing KRT in Australia using data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry. All patients who initiated dialysis in Australia from January 1971 to 31 December 2021 were included. Confidence intervals around rates were calculated and compared using Poisson distributions. RESULTS: During the study period, a total of 31,834 women and 47,718 men were recorded in ANZDATA to have commenced KRT in Australia, a male-to-female ratio of 1.51 (1.49-1.53). The male-to-female ratio increased over time from 1.05 (0.83-1.34) in 1971 to 1.78 (1.66-1.92) in 2021. There was a progressive increase in the male:female ratio with age; for those starting in 2017-21, this rose from 1.37 (95% CI: 1.26-1.50) among 25-44-year-olds to 4.38 (2.47-5.53) among those ≥85 years at KRT start. CONCLUSION: Men had a significantly higher rate of starting KRT in Australia compared with women, and this difference is increasing over time. This disparity also varied between types of primary kidney disease but was higher among older age groups. It is still seen for causes (such as polycystic kidney disease) that have theoretically equal gender disease distribution, suggesting differences in propensity to commence KRT as well as differences in underlying disease processes.