Sex-based variations in PD outcomes.

This letter comments on the study by Thongprayoon et al., which examines sex disparities in outcomes among patients undergoing peritoneal dialysis (PD). While the analysis of a large national dataset offers valuable insights, the absence of dialysis-specific parameters such as residual renal function and dialysis vintage may limit causal interpretation. The finding that women were less likely to switch to hemodialysis, particularly younger patients without cardiovascular disease, is noteworthy. Complementary Australian registry data indicate that men are more likely to discontinue PD due to inadequate dialysis, mediated mainly by comorbidities. Together, these findings emphasize that sex differences in PD outcomes are multifactorial and shaped by comorbidity and care delivery rather than sex alone.