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Victoria Riehl-Tonn, PhD Candidate

Supervisor(s):  Sofia Ahmed
Award:  KRESCENT  Allied Health Kidney Doctoral Fellowship
Institution:  University of Calgary
Year:  2023-2026

Study title: Sex and Gender Considerations in Patient Outcomes in Individuals Living with Chronic Kidney Disease (Sex and Gender Differences May Impact Patient Outcomes in Hemodialysis) 

Victoria Riehl-Tonn is a registered nurse and doctoral student under the supervision of Dr. Sofia Ahmed at the University of Calgary. Her research focuses on patient outcomes in people living with chronic kidney disease and how they differ by sex and gender. She is passionate about leading patient-oriented kidney research and building research capacity.

Her goal is to develop an expertise in kidney science with a sex and gender focus and patient-oriented research to ultimately become an independent investigator, with the aim of filling this gap in the global kidney research ecosystem.
Lay Summary
Kidney disease is a global epidemic, affecting 1 in 10 Canadians, a number that has increased on average 1.6% annually. The care of individuals living with chronic kidney disease (CKD), including hemodialysis, is a one-size-fits-all approach to care that does not account for sex and gendered factors. This approach to care may underestimate hemodialysis adequacy in females and in turn exacerbate poor outcomes, such as increased risk of death and decreased quality of life compared to males. Additionally, sex- and gender-related factors such as dialysis dose and type of dialysis may be predictors of poor outcomes in females.

Purpose: The role of sex (biological) and gender (sociocultural) play in patient outcomes are not well understood. This project will provide an improved understanding of sex and gender differences, inform precision medicine, and promote outcomes for individuals living with CKD. Methods: This will be done in three parts. First, we will administer a survey and interview to individuals with chronic kidney disease planning to start dialysis to assess their sociocultural gender. We will aim to see how sex and gender play a role in individual’s decision making on the type of dialysis they would be most likely to choose as their first form of kidney replacement therapy. In the second part, we will administer a quality of life survey to patients starting hemodialysis across Alberta along with a gender survey to understand how sex and gender may influence this important patient outcome. Finally, we will also do a systematic review of the literature to understand how adequate dialysis sessions may be associated with cardiovascular mortality may differ between females and males. This will help us to understand the role biological sex has on how adequate each dialysis session is and cardiovascular health.

Anticipated Outcomes: Females and women will experience worse outcomes and be more likely to pick home-based dialysis compared to males and men. Patient Engagement: Following the Patient-Oriented Research Level of Engagement Tool (Saskatchewan Centre for Patient-Oriented Research, 2021), patient partners are integrated as empowered team members in a multidisciplinary team and will help develop appropriate knowledge translation strategies. Patients and providers will be actively involved at every stage of the research process through identifying research topics, objectives, recruitment strategies, recruitment materials, survey design, methodology, and effective dissemination techniques. Part of our team is an individual living with kidney failure who is a member of the Kidney Foundation of Canada Patient Advisory Board, this individual’s part of the research process at all stages. They have already also provided feedback on abstracts, posters, presentations, and manuscripts and are co-author on all work, including published abstracts (2022 Journal of American Society of Nephrology) and poster presentations (2022 American Society of Nephrology).

Relevance to Patients/Community: In Canada, 1 in 10 individuals live with CKD, a number that has increased by 7.1% in 2 years. CKD is associated with increased mortality and morbidity and presents a substantial burden to the healthcare system. This project will advance healthcare practices to improve outcomes for people living with CKD through engaging patients and providers, addressing patient-identified priorities, and understanding sex- and gender-differences. Conducting research on patient-identified priorities, implementing strategies to improve outcomes, and reducing healthcare costs address important needs for all Canadians.

Conclusion: Despite the important sex- and gender-related divergence in patient outcomes, guidelines for the care of dialysis patients still remain sex- and gender-blind. Highlighting sex- and gender-differences will inform precision medicine, promote an individualized approach to care, reduce the healthcare burden experienced by the prevalence of CKD, and in turn improve the health of Canadians living with CKD.