Sex disparities in the utilization of nurse-assisted peritoneal dialysis: a mediation analysis using data from the REIN registry

Isabelle Danneville; Mathilde Beaumier; Annabel Boyer; Valérie Chatelet; Elisabeth Monnet; Stéphane Edet; Antoine Lanot; Clémence Bechade; Thierry Lobbedez

doi:10.1093/ckj/sfad301

Sex disparities in the utilization of nurse-assisted peritoneal dialysis: a mediation analysis using data from the REIN registry

Clin Kidney J. 2024 Jan 3;17(1):sfad301. doi: 10.1093/ckj/sfad301. eCollection 2024 Jan.

Authors

Isabelle Danneville¹, Mathilde Beaumier^{1

2

3}, Annabel Boyer^{1

2

3}, Valérie Chatelet^{1

2

3}, Elisabeth Monnet⁴, Stéphane Edet⁵, Antoine Lanot^{1

2

3}, Clémence Bechade^{1

2

3}, Thierry Lobbedez^{1

2

3}

Affiliations

¹ CHU de Caen Normandie, Centre Universitaire des Maladies Rénales, Caen, France.
² Normandie Université, UNICAEN, UFR de Médecine, Caen, France.
³ «ANTICIPE», U1086 Inserm-UCN, Centre de Lutte Contre le Cancer François Baclesse, Caen, France.
⁴ CIC-1431 INSERM, CHU Besançon, Université de Franche-Comté, Besançon Cedex, France.
⁵ Department of Nephrology and Haemodialysis, Rouen University Hospital, France - ANIDER Rouen Normandie, Rouen, France.

Abstract

Background: This study was carried out to evaluate the association between patient sex and the proportion of nurse-assisted peritoneal dialysis (PD) at dialysis initiation and to explore whether sex disparities in nurse-assisted PD utilization was explained by predialysis care and/or by social deprivation using mediation analysis.

Methods: This was a retrospective study using data from the Renal Epidemiology and Information Network (REIN) registry linked to the French National Healthcare Database (SNDS) of incident patients between 1 January 2017 and 30 June 2018. A regression logistic was used for statistical analysis. A mediation analysis explored the direct effect of sex on nurse-assisted PD proportion and the indirect effect through the European Deprivation Index (EDI), and the number of general practitioner (GP) and nephrologist visits before dialysis initiation.

Results: Among 1706 patients on PD, there were 637 women (37.3%) and 1069 men (62.7%). Nurse-assisted PD proportion was 332/610 (54.4%) for women vs 464/1036 (44.8%) for men. In the multivariable analysis women were more likely to be treated by nurse-assisted PD {odds ratio (OR) 1.92 [95% confidence interval (CI) 1.46-2.52]}. Nurse-assisted PD was associated with the median number of GP visits [OR 1.44 (95% CI 1.11-1.86)] and with the median number of nephrologist visits [OR 0.59 (95% CI 0.46-0.76)]. The mediation analysis showed a direct effect of sex on nurse-assisted PD [OR 1.90 (95% CI 1.80-2.01)] and an indirect effect through the median number of GP visits [OR 1.05 (95% CI 1.04-1.06], the median number of nephrologist visits [OR 1.02 (95% CI 1.02-1.03)] and quintile 5 of the EDI [OR 1.03 (95% CI 1.02-1.03)].

Conclusion: Women were more frequently treated by nurse-assisted PD than men. Differences between women and men in predialysis care and social deprivation could explain the greater utilization of nurse-assisted PD among women.

Keywords: assisted peritoneal dialysis; mediation analysis; peritoneal dialysis; predialysis care; sex.