Sex disparities in mortality among patients with kidney failure receiving dialysis

Jung, Hojin; Jeon, Yena; Kim, Yon Su; Kang, Shin‐Wook; Yang, Chul Woo; Kim, Nam-Ho; Noh, Hee-Won; Jeon, Soojee; Lim, Jeong-Hoon; Choi, Ji-Young; Cho, Jang‐Hee; Park, Sun-Hee; Kim, Chan‐Duck; Kim, Yong-Lim

doi:10.1038/s41598-022-16163-w

Cited by 7 publications

(3 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 43 Another study that included only Korean patients with kidney failure on dialysis reported that the survival advantage in women as seen in the general population was maintained but did not find any difference in cardiovascular‐related death between men and women. 44 It is well known that among people with ESKD requiring maintenance dialysis, women lose the survival advantage over men, as seen in the general population, possibly related to cardiovascular risk, hormonal factors, differences in vascular access, comorbidities, anemia management, and socioeconomic factors. 45 In the general population, menopause (and particularly early menopause) is associated with an increased incidence of cardiovascular disease and mortality.…”

Section: Discussionmentioning

confidence: 99%

Sex Differences in Cardiovascular Outcomes in Patients With Kidney Failure

Shah,

Christianson,

Meganathan

et al. 2024

JAHA

View full text Add to dashboard Cite

Background Cardiovascular disease is the leading cause of mortality in patients with kidney failure, and their risk of cardiovascular events is 10 to 20 times higher as compared with the general population. Methods and Results We evaluated 508 822 patients who initiated dialysis between January 1, 2005 and December 31, 2014 using the United States Renal Data System with linked Medicare claims. We determined hospitalization rates for cardiovascular events, defined by acute coronary syndrome, heart failure, and stroke. We examined the association of sex with outcome of cardiovascular events, cardiovascular death, and all‐cause death using adjusted time‐to‐event models. The mean age was 70±12 years and 44.7% were women. The cardiovascular event rate was 232 per thousand person‐years (95% CI, 231–233), with a higher rate in women than in men (248 per thousand person‐years [95% CI, 247–250] versus 219 per thousand person‐years [95% CI, 217–220]). Women had a 14% higher risk of cardiovascular events than men (hazard ratio [HR], 1.14 [95% CI, 1.13–1.16]). Women had a 16% higher risk of heart failure (HR, 1.16 [95% CI, 1.15–1.18]), a 31% higher risk of stroke (HR, 1.31 [95% CI, 1.28–1.34]), and no difference in risk of acute coronary syndrome (HR, 1.01 [95% CI, 0.99–1.03]). Women had a lower risk of cardiovascular death (HR, 0.89 [95% CI, 0.88–0.90]) and a lower risk of all‐cause death than men (HR, 0.96 [95% CI, 0.95–0.97]). Conclusions Among patients undergoing dialysis, women have a higher risk of cardiovascular events of heart failure and stroke than men. Women have a lower adjusted risk of cardiovascular mortality and all‐cause mortality.

show abstract

Section: Discussionmentioning

confidence: 99%

Sex Differences in Cardiovascular Outcomes in Patients With Kidney Failure

Shah,

Christianson,

Meganathan

et al. 2024

JAHA

View full text Add to dashboard Cite

show abstract

“…The prognostic factors associated with the female gender that cause this decrease in survival remain controversial. A less protective effect of body mass index (BMI) on HD mortality, associated with a different rate of skeletal muscle and fat due to sex hormones, is one of the most recent hypotheses [25]. However, the effect of diabetes is the most reported interaction factor on the different survival rates observed between sexes in all causes of death [24][25][26].…”

Section: Discussionmentioning

confidence: 99%

Years of Potential Life Lost on Renal Replacement Therapy: Retrospective Study Cohort

Muñoz-Terol

Rocha

Nuez³

et al. 2022

JCM

View full text Add to dashboard Cite

Background: Chronic kidney disease is the non-communicable disease with the highest growth in morbidity and mortality. Renal transplantation (RT) is the first option of renal replacement in end-stage kidney disease (ESKD) and dialysis is an alternative. However, there is no objective quantification of the impact of both options on a patient’s overall survival. The purpose of our study is to assess the potential years of life lost by patients on renal replacement therapy. Methods: Retrospective study cohort conducted from 2008 to 2018 based on autonomic data registry. Results: 11,551 patients included who received renal replacement therapy (RRT) in a range of age from 15 to 94 years. The mean age at the time of onset was 62.7 years, 95% confidence interval (95% CI) (62.4; 63.0). The mortality rate of RRT patients was 42.2%, 95% CI (41.5; 43.3) and the mean age at death was 72.7 years, 95% CI (72.4; 73.1). The number of patients with ESKD treated with RT was 3776, 32.7% of the total, 95% CI (31.8; 33.5). The total amount of years of potential life lost (YPLL) in the entire cohort was 77,831.3 years, 48,010.1 years in men, and 29,821.2 years in women. The mean number of YPLL per patient with RRT was 6.74 years in both sexes, 6.95 years in women, and 6.61 years in men. The mean number of potential years of life lost in dialysis patients was 9.0 years in both sexes, 8.8 years in men, and 9.2 years in women, while among kidney transplant recipients this figure decreased to 2.2 years in both men and women. Conclusions: End-stage chronic kidney disease in renal replacement therapy by dialysis causes an average of 9.0 years of life potentially lost for each patient on dialysis treatment, while having received a kidney transplant reduces this figure by 75.6%.

show abstract

“…There is a lack of data from the Asian population and no data from India regarding the sex disparity in practice patterns of hemodialysis patients. Only one study from Korea showed that women had better survival than men on dialysis due to a lower risk of non-infection and non-cardiovascular related mortality ( 5 ). We aimed to evaluate distinctions in hemodialysis-related attributes between sexes in two state government-run hemodialysis centers in South India.…”

Section: Introductionmentioning

confidence: 99%

Gender disparity in maintenance hemodialysis units in South India: a cross-sectional observational study

Shankar,

Satheesh,

et al. 2024

Front. Nephrol.

View full text Add to dashboard Cite

BackgroundDiseases manifest differently according to gender in many medical specialties. However, sex differences in kidney diseases have not been well explored worldwide, especially in India. These differences could also be attributed to sociocultural factors. Although CKD is more prevalent in women worldwide, most men are initiated on kidney replacement therapy (KRT). This study aimed to examine sex disparities in patients on maintenance hemodialysis.Materials and methodsA cross-sectional observational study was conducted in two maintenance hemodialysis units at the Institute of Nephrourology, a tertiary care referral government center in Bengaluru, India. Demographic characteristics and laboratory parameters were also recorded.ResultsIn total, 374 adult patients (aged >18 years) were included in the study. Most patients (72.7%) were men. Mean age in men was 46.95 ± 12.65 years, and women was 46.63 ± 13.66 years. There was no significant difference in marital status and the availability of caretakers between the groups. Spouses were the predominant caretakers for both sexes (64% men and 51% women, P = 0.14). Sons cared more for patients with mother than fathers (19.6% vs 8.8%, P = 0.074). Diabetic nephropathy was the most common cause of ESKD in both groups (33.1% vs 31.3%, P = 0.92). Men had a significantly longer duration of HTN and received more HD sessions per week than women. Mean hemoglobin (9.9 ± 1.79 vs 9.46 ± 1.47 g%) and mean serum creatinine (7.76 ± 2.65 vs 6.41 ± 2.27 mg/dl) were higher in men compared to women (P <0.002). Intradialytic complications, such as hypotension and cramps, were significantly more common in women than in men (P = 0.004). Most men (47.1%) were planning a kidney transplant (and were waitlisted) compared with fewer women (43%). There was no significant difference in the average number of hospitalizations per month or HD vintage.ConclusionWomen tend to initiate dialysis later, and a lesser number are waitlisted for kidney transplantation, which might be partly related to varying access to or delivery of health care services. Factors such as lack of education, insufficient identification of and strategies to address cultural obstacles to healthcare, and a shortage of financial means to afford medical care are potentially correctable elements that might explain this discrepancy.

show abstract

Sex disparities in mortality among patients with kidney failure receiving dialysis

Cited by 7 publications

References 26 publications

Sex Differences in Cardiovascular Outcomes in Patients With Kidney Failure

Sex Differences in Cardiovascular Outcomes in Patients With Kidney Failure

Years of Potential Life Lost on Renal Replacement Therapy: Retrospective Study Cohort

Gender disparity in maintenance hemodialysis units in South India: a cross-sectional observational study

Contact Info

Product

Resources

About