Sex-Stratified Sociodemographic and Clinical Profile of Maintenance Hemodialysis Patients at a Remote Island Hospital in Bali: A Cross-Sectional Study

Abstract

Background: Chronic kidney disease is a growing burden in Indonesia, yet the hemodialysis population of small remote islands is undescribed, and whether reported sex disparities appear there is unknown.

Objective: To profile, by sex, all maintenance hemodialysis patients at an island hospital on Nusa Penida, Bali, and to benchmark key indicators against national and regional reference populations.

Methods: This retrospective cross-sectional study included all 31 patients with stage 5 chronic kidney disease on maintenance hemodialysis in January–March 2026. Proportions with 95% Wilson intervals were compared with benchmarks by exact binomial tests; sex differences used Fisher exact tests with Holm correction. Other bivariate associations and Firth multivariable models for catheter use, hemoglobin ≤10 g/dL and non-employment were analyzed across all datasets consistent with the observed counts.

Results: Sixteen patients (51.6%) were women; 58.1% were aged ≥51 years. Hypertensive nephrosclerosis was the recorded etiology in 58.1% (95% CI 40.8–73.6), 41.9% were dialyzed through a double-lumen catheter, 61.3% had hemoglobin ≤10 g/dL, 71.0% were not employed, and none was HBsAg-positive. Fistula use was lower than in Chinese (84.7%) and Japanese (90.7%) cohorts (Holm-adjusted p≤0.004). Women less often had senior high school education or higher (18.8% vs 73.3%; Holm-adjusted p=0.042). In multivariable models, female sex showed the largest adjusted association with non-employment (median OR 4.68), but no predictor was significant across all consistent datasets.

Conclusion: Patients were mostly aged 51–70 years, largely unemployed, and frequently catheter-dependent and anemic, with a pronounced educational disadvantage among women; a patient-level registry should address the access and anemia gaps identified.