Is There Gender Difference in Maintenance of Peritoneal Dialysis: Analysis Using Competing Risk Model

Friday, 28 July 2017

Hsiao-Ling Chen, MS
Jin-Lain Ming, MS
Nursing Department, Taipei Veterans General Hospital, Taipei, Taiwan

Purpose: Peritoneal dialysis (PD) is one choice of renal replacement therapies in patients with end-stage renal disease (ESRD). Gender difference was known with involving long-term outcome of nursing care such as quality of life among ostomy patients. However, little is known about the gender difference of PD usage and maintenance. This retrospective study aimed to clarify the gender effect on withdrawing PD.

Methods: ESRD patients, who had received PD catheter insertion, were enrolled in a tertiary hospital in northern Taiwan. The clinical data were reviewed and analyzed for the outcomes of PD-withdrawing time and events using competing risks regression model. Receiving renal transplantation or death was considered as a competing risk for the outcomes of withdrawing PD. Univariate analysis model was used to investigate the relationship between each independent variable, while multivariate analysis model was used to determine the independent variables that continued to be associated with outcomes after inclusion with significant variables in univariate analysis. Subdistribution hazard ratios (SHR) of covariates of competing risks regression were expressed with respective confidence intervals of 95%. Data were analyzed using the software Stata 12.0. Pvalue less than 0.05 is considered statistically significant.

Results: A total of 514 patients receiving PD were enrolled for analysis between 2001 and 2013. One hundred and four patients (26%) had events of PD infection or malfunction and received removal of the PD catheter. Forty patients had received renal transplantation and avoided PD thereafter. Eighty-three patients had mortality events and 79 of them died with functioning PD. In the competing risk regression model, female patients had fewer events to remove PD catheter than male (SHR 0.67, 95% confidence interval 0.48-0.94, p = 0.019).

Conclusion:  Male is a risk factor to have episode for removal of their PD catheters. Women may keep longer duration of PD usage and gender difference affects maintenance of PD catheters. Caring PD catheter is essential for ESRD patients and requiring self-care education. Gender difference for the maintenance of PD should be considered for further patient education and individual care.