EXPLORING THE ASSOCIATION OF SEX/GENDER DISPARITIES WITH ALL-CAUSE AND CAUSE-SPECIFIC PERITONEAL DIALYSIS DISCONTINUATION: A MULTIPLE MEDIATION ANALYSIS
Dr Dharshana Sabanayagam1,2,3, Dr Pedro Lopez4,5,6, Dr Farzaneh Boroumand1,2, Dr Katrina Chau7,8, Dr Eric Au9,10,11, Dr Ryan Gately12,13, Dr Shuvo Baker1, Dr Lin Zhu1, Professor Wai Lim4,14, Professor Armando Teixeira-Pinto1,2, Professor Germaine Wong1,2,3
1Sydney School of Public Health, University of Sydney, Sydney, Australia, 2Centre for Kidney Resarch, The Children’s Hospital at Westmead, Westmead, Australia, 3Department of Renal and Transplantation Medicine, Westmead Hospital, Westmead, Australia, 4Faculty of Health & Medical Sciences, University of Western Australia, Perth, Australia, 5Pleural Medicine Unit, Institute for Respiratory Health, Perth, Australia, 6Grupo de Pesquisa em Exercício para Populações Clínicas (GPCLIN), Universidade de Caxias do Sul, Caxias do Sul, Brazil, 7School of Medicine, Western Sydney University, Campbelltown, Australia, 8Department of Renal Medicine, Blacktown Hospital, Blacktown, Australia, 9Australia & New Zealand Dialysis & Transplant Registry, South Australian Health & Medical Research Institute, Adelaide, Australia, 10School of Population and Global Health, University of Melbourne, Victoria, Australia, 11The Alfred Hospital, Victoria, Australia, 12Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Australia, 13School of Medicine, The University of Queensland, Brisbane, Australia, 14Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia
Introduction: Little is known about sex/gender differences in cause-specific peritoneal dialysis (PD) discontinuation. We aimed to assess the mediating effects of sociodemographic factors and comorbidities on the association between sex/gender differences, all-cause and cause-specific PD discontinuation.
Methods: Incident patients starting PD between 2005-2019 were identified using the ANZDATA registry. Adjusted Cox proportional hazards models were used to determine the association between sex/gender and all-cause (transfer to haemodialysis for ≥30 days or death), inadequate dialysis-related and infection-related PD discontinuation. Counterfactual mediation analysis was conducted to decompose the total effects of sex/gender on all-cause and cause-specific PD discontinuation, into direct and indirect effects, adjusting for mediator-exposure and mediator-outcome confounders.
Results: 6001 out of 9748 included patients experienced all-cause PD-discontinuation (2098 died, 813 inadequate dialysis-related, 1510 infection-related). In the adjusted Cox model (HR, 95%CI), men were more likely to experience all-cause (1.08, 1.03-1.14, p=0.002) and inadequate dialysis-related PD discontinuation (1.68, 1.48-1.95, p < 0.001), but not infection-related PD discontinuation (0.93, 0.83-1.03, p=0.14). The mediation analyses found that men were more likely to experience all-cause PD discontinuation (1.08, 1.02-1.14, p=0.012). 72% of the total effect was explained by mediators, including cardiovascular disease (47.5%), smoking status (23.2%) and diabetes (16.9%). Men were more likely to experience PD discontinuation due to inadequate dialysis (2.39, 1.05-5.75, p=0.038), however, only 5.6% of the total effect was explained by mediators
Conclusion: Men were more likely to experience all-cause and inadequate dialysis-related PD discontinuation than women. The effects of sex/gender on all-cause PD discontinuation, were mediated by CVD, smoking status and diabetes. Future studies may consider evaluating these intermediate markers as potential modifiable factors in clinical trials involving patients undergoing PD.
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Biography:
Biography:
Dharshana Sabanayagam is an adult nephrologist, working as a Post-Graduate Fellow at Westmead Hospital. She is also enrolled in a Doctorate of Philosophy with the University of Sydney, with a focus on optimisation of dialysis initiation in people with kidney failure.