Gender-specific discrepancy in subjective global assessment for mortality in hemodialysis patients

Ko, Ye Eun; Yun, Taeyoung; Lee, Hye Ah; Kim, Seung Jung; Kang, Duk Hee; Choi, Kyu Bok; Kim, Yon Su; Kim, Yong Lim; Oh, Hyung Jung; Ryu, Dong Ryeol

doi:10.1038/s41598-018-35967-3

Cited by 8 publications

(3 citation statements)

References 31 publications

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“…This could explain the lower Hb levels in the incident HD group, with consequent more need for erythropoietin therapy to correct the anemia and try to reach target Hb level. In harmony with these data, many previous studies reported significantly lower blood hemoglobin, and serum albumin, creatinine, and phosphorus levels in the incident than in the prevalent HD patients [4,18,19].…”

Section: Discussionsupporting

confidence: 63%

Differences between the Incident and Prevalent Hemodialysis Patients in Egypt

Megahed

El-Said

Abdelhady

et al. 2020

AJMAH

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Background and Aim: The number of patients on hemodialysis (HD) increases continuously. The HD population is usually divided into early and late HD patients according to the duration of HD, that are known as incident and prevalent groups. Still, there is a debate about the exact definition of both the incident and prevalent groups. Furthermore, predictors of death of both of these groups are not yet identified, especially in Egyptian HD patients. We aimed to compare between the incident and prevalent HD patients as well as to define predictors of mortality among each of these groups. Study Design and Methodology: This prospective multicenter study was started in June 2016, comprising 2123 HD patients recruited from twenty-five Egyptian HD centers. Patients were classified according to HD duration into two groups: Incident group including patients with HD duration equals to or less than 6 months, and a prevalent group including patients who had been maintained on HD for more than 6 months. All patients were observed for one and half years and their demographic data, laboratory findings and mortality events were recorded. Results: In comparison to the prevalent group, the incident HD patients showed significantly lower hemoglobin, serum albumin, urea reduction ratio, serum phosphorus, and serum ferritin but higher average erythropoiesis stimulating agents (ESA) dose. There was significantly a higher number of patients with hypertension in the incident group, while there was no significant difference in diabetes mellitus or ischemic heart disease in both groups. There were a higher number of patients with positive hepatitis C virus antibodies and hyperparathyroidism in the prevalent group. By the end of the study, the mortality frequency was found to be significantly higher in the incident than the prevalent groups. Older age and corrected serum calcium were significant predictors of mortality in the total studied group as well as the prevalent group. However, no significant predictors of mortality could be detected among the incident group. Conclusion: The incident HD group tends to show higher frequency of hypertension, laboratory findings suggestive of malnutrition as well as higher frequency of mortality with different pattern of mortality predictors compared to the prevalent group.

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Section: Discussionsupporting

confidence: 63%

Differences between the Incident and Prevalent Hemodialysis Patients in Egypt

Megahed

El-Said

Abdelhady

et al. 2020

AJMAH

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“…In this study, analysis of the sex interaction showed that the risk of all-cause death associated with BMI was lower in male patients on HD than in female patients on HD. Previous studies from the present Korean kidney failure cohort have reported that BMI or subjective global assessment (SGA) could be useful for predicting mortality in male patients on HD but not in female patients on HD 21,22 . A greater protective effect www.nature.com/scientificreports/ of higher BMI on survival in male patients on dialysis than female patients on dialysis could be explained by higher skeletal muscle mass and reduced fat mass associated with sex hormones in males 23 and a sex-specific association of skeletal muscles mass and arterial stiffness in dialysis patients 24 .…”

Section: Discussionmentioning

confidence: 90%

Sex disparities in mortality among patients with kidney failure receiving dialysis

Jung

Jeon

Kim

et al. 2022

Sci Rep

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Females are known to have a better survival rate than males in the general population, but previous studies have shown that this superior survival is diminished in patients on dialysis. This study aimed to investigate the risk of mortality in relation to sex among Korean patients undergoing hemodialysis (HD) or peritoneal dialysis (PD). A total of 4994 patients with kidney failure who were receiving dialysis were included for a prospective nationwide cohort study. Cox multivariate proportional hazard models were used to determine the association between sex and the risk of cause-specific mortality according to dialysis modality. During a median follow-up of 5.8 years, the death rate per 100 person-years was 6.4 and 8.3 in females and males, respectively. The female-to-male mortality rate in patients on dialysis was 0.77, compared to 0.85 in the general population. In adjusted analyses, the risk of all-cause mortality was significantly lower for females than males in the entire population (hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.71–0.87, P < 0.001). No significant differences in the risk of cardiovascular and infection-related deaths were observed according to sex. The risk of mortality due to sudden death, cancer, other, or unknown causes was significantly lower for females than males in the entire population (HR 0.66, 95% CI 0.56–0.78, P < 0.001), in patients on HD (HR 0.75, 95% CI 0.62–0.90, P = 0.003), and in patients on PD (HR 0.49, 95% CI 0.34–0.70, P < 0.001). The survival advantage of females in the general population was maintained in Korean dialysis patients, which was attributed to a lower risk of noncardiovascular and noninfectious death.Trial registration: ClinicalTrials.gov Identifier: NCT00931970.

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“…A possible explanation could be the gender-specific discrepancy that may exist in the association between SGA and mortality. Recently, Ko et al [27] reported that a mortality risk of 'mild-to-severe malnutrition' evaluated by SGA was observed in male patients but not in female patients. In addition, results from a number of epidemiologic studies with large cohorts of HD patients indicated an 'obesity paradox', suggesting that obesity was associated with better survival [28].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of body composition monitoring for assessment of nutritional status in hemodialysis patients

et al. 2019

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Background: Body composition monitoring is the only clinically available method for distinguishing among the three body components. This study aimed to determine the relationship between body composition and all-cause mortality in Chinese hemodialysis patients and examine whether the lean tissue index (LTI) derived from body composition monitoring can accurately diagnose malnourished patients. Methods: Hemodialysis patients (n ¼ 123) with nutritional and body composition assessment records in 2015 were examined. Body composition was assessed using a body composition monitor machine. Results: Fifty-seven patients (46.3%) had low LTI (LTI less than the 10th percentile of the respective normal distribution). Significant differences in the fat tissue index (FTI) were observed, with the low LTI group having a higher FTI (10.8 kg/m 2 vs. 9.0 kg/m 2 , p¼ .007). The kappa coefficient of agreement between LTI and subjective global assessment (SGA) was 0.26 for the presence of malnutrition. During the mean observation period of 26.7 months, 20 of 123 (16.3%) patients died. Low LTI remained highly predictive of survival in the Cox regression analysis (hazard ratio: 3.24, 95% confidence interval 1.06-9.91, p¼ .04). Malnourishment defined by SGA predicted survival in the Kaplan-Meier analysis (log-rank v 2 ¼4.05; p¼ .04) but not in the multivariate analysis. Conclusions: LTI is a predictor of mortality, and its predictive power was not affected when FTI, SGA, and hydration status were included in the multivariate analysis. However, SGA may not be adequate to identify patients at a risk of death among Chinese hemodialysis patients.

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Gender-specific discrepancy in subjective global assessment for mortality in hemodialysis patients

Cited by 8 publications

References 31 publications

Differences between the Incident and Prevalent Hemodialysis Patients in Egypt

Differences between the Incident and Prevalent Hemodialysis Patients in Egypt

Sex disparities in mortality among patients with kidney failure receiving dialysis

Evaluation of body composition monitoring for assessment of nutritional status in hemodialysis patients

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