Gender-Related Factors Influencing Choice of Home Dialysis: A Mixed-Methods Study

Rationale & Objective Compared with in-center dialysis, home dialysis is associated with improved health outcomes and lower cost, yet it may be underutilized. How gender factors influence choice of dialysis is unclear. Study Design Explanatory sequential mixed-methods study. Setting & Participants Adults with stage G4-5 chronic kidney disease without kidney replacement therapy attending dialysis modality education sessions in Calgary, Canada. Analytical Approach Gender factors (ie, identity, roles) were assessed by 2 self-administered validated surveys to derive a composite measure of gender. We described associations between gender factors and participants' reported choice of dialysis modality. Semistructured interviews were offered to survey respondents and analyzed using inductive content analysis. Results Twenty-four respondents (median [interquartile range, IQR] estimated glomerular filtration rate, 14 mL/min/1.73 m 2 [IQR, 12-16]) participated (8 women, 59 [IQR, 51-70] years; 12 men, 74 [IQR, 68-75] years; 3 gender-diverse persons, 40 [IQR, 38-40] years). Gender scores were low (women 8 [IQR, 5-46], men 23 [IQR, 6-48], and gender-diverse 28 [IQR, 6-50]), consistent with having more roles traditionally ascribed to men and fewer traditionally ascribed to women. Most participants (88% women, 100% men, and 67% gender-diverse) reporting being likely/very likely to choose home dialysis had numerically but not significantly lower gender scores (10 [IQR, 6-46]) compared with those reporting being likely/very likely to choose in-center hemodialysis (36 [IQR, 5-66]) ( P = 0.51). Factors influencing the choice of dialysis modality differed by gender identity, and participants reporting being likely/very likely to choose home dialysis tended to have fewer responsibilities commonly attributed to women and more responsibilities commonly attributed to men in Western society. During interviews (n=7), most women described a desire to maintain independence with home dialysis, whereas some men discussed relying on their partners for support in managing home dialysis. Limitations Limited ability to detect differences because of small sample size. Conclusions Gender factors may influence dialysis modality choice, although further study is needed. Understanding how gender factors shape decision-making could inform strategies supporting uptake of home dialysis. Plain-Language Summary Home dialysis offers advantages compared with in-center hemodialysis, yet uptake remains limited. How gender factors, including identity and roles and responsibilities, influence an individual's likelihood of choosing home compared with in-center dialysis is unknown. Using both a survey and interviews, we described associations between gender factors and participants' reported choice of dialysis modality in adults with advanced chronic kidney disease after they had completed a dialysis modality education session. Factors shaping home dialysis choice differed by gender identity and roles. Interviews suggested women valued independence with home dialysis, whereas some men anticipated partner support for home dialysis. Although limited by sample size and generalizability, these findings suggest that gender factors may influence decision-making about home dialysis.