Sex-specific analysis of haemodialysis prevalence, practices and mortality over time: the Austrian Dialysis Registry from 1965 to 2014

Kainz, Alexander; Berner, Carolin; Ristl, Robin; Simon, A.; Stamm, Tanja; Zitt, Emanuel; Kramar, Reinhard; Antlanger, Marlies; Kautzky‐Willer, Alexandra; Schmaldienst, Sabine; Schernhammer, Eva; Port, Friedrich K.; Carrero, Juan Jesús; Jager, Kitty J.; Hecking, Manfred

doi:10.1093/ndt/gfy322

Cited by 20 publications

(19 citation statements)

References 33 publications

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“…The findings that, in all European countries reporting to the ERA-EDTA Registry, a higher number and a higher percentage of men compared with women initiated any type of KRT during the last five decades, and that the proportion of women on KRT remained constant throughout the study period, are consistent with our previous report from a national HD registry (14). The reasons for these observations are currently unclear.…”

Section: Discussionsupporting

confidence: 89%

Sex Differences in Kidney Replacement Therapy Initiation and Maintenance

Antlanger

Noordzij

Luijtgaarden

et al. 2019

CJASN

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Background and objectives More men than women undergo kidney replacement therapy (KRT) despite a larger number of women being affected by CKD. The aim of this multinational European study was to explore whether there might be historic and geographic trends in sex-specific incidence and prevalence of various KRT modalities. Design, setting, participants, & measurements We assessed sex-specific differences in KRT incidence and prevalence using data from nine countries reporting to the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Registry for at least 40 years, during the period 1965-2015. Sex distribution data were compared with the European general population (Eurostat). Statistical methodology included basic descriptive statistics, incidence and prevalence calculations per million population (pmp), as well as their male-tofemale ratios. Analyses were stratified by age group and diabetic status. Results We analyzed data from 230,378 patients receiving KRT (38% women). For all KRT modalities, the incidence and prevalence rates were consistently higher in men than women. For example, the KRT incidence increased from 8 pmp in 1965-1974 to 98 pmp in 2005-2015 in women, whereas it rose from 12 to 173 pmp in men during the same period. Male-to-female ratios, calculated for incident and prevalent KRT patients, increased with age (range 1.2-2.4), showing consistency over decades and for individual countries, despite marked changes in primary kidney disease (diabetes more prevalent than glomerulonephritis in recent decades). The proportion of kidney transplants decreased less with age in incident and prevalent men compared with women on KRT. Stratified analysis of patients who were diabetic versus nondiabetic revealed that the male-to-female ratio was markedly higher for kidney transplantation in patients with diabetes. Conclusions Since the beginning of KRT programs reporting to the ERA-EDTA Registry since the 1960s, fewer women than men have received KRT. The relative difference between men and women initiating and undergoing KRT has remained consistent over the last five decades and in all studied countries.

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Section: Discussionsupporting

confidence: 89%

Sex Differences in Kidney Replacement Therapy Initiation and Maintenance

Antlanger

Noordzij

Luijtgaarden

et al. 2019

CJASN

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“…CKD occurs in consequence of kidney damage and is usually characterized by a gradual loss of kidney function, ultimately leading to kidney failure requiring kidney replacement therapy, (most often by hemodialysis) [4], in those individuals who have not previously died [5]. Importantly, while US women have a higher cumulative lifetime risk than men of developing CKD [6], their likelihood of initiating and receiving kidney replacement therapy as prevalent dialysis patients is actually lower, in the US [7] and elsewhere [7][8][9]. The higher CKD lifetime risk of women has been confirmed on the population level, and for non-US countries.…”

Section: Introductionmentioning

confidence: 99%

Sex differences in chronic kidney disease awareness among US adults, 1999 to 2018

et al. 2020

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Background Chronic kidney disease (CKD) is less prevalent among men than women, but more men than women initiate kidney replacement therapy. Differences in CKD awareness may contribute to this gender gap, which may further vary by race/ethnicity. We aimed to investigate trends in CKD awareness and the association between individual characteristics and CKD awareness among US men versus women. Methods and findings We conducted a serial, cross-sectional analysis of 10 cycles (1999–2018) from the National Health and Nutrition Examination Survey (NHANES). Adult participants with CKD stages G3-G5 (estimated glomerular filtration rate [eGFR] <60 mL/min/1.73m2) were included, unless they were on dialysis or medical information was missing. Serum creatinine was measured during NHANES medical exams. CKD stage was classified by eGFR, based on the CKD-EPI formula. CKD awareness was assessed with the question: “Have you ever been told by a health care professional you had weak or failing kidneys”, asked in standardized NHANES questionnaires on each survey. Using logistic regression models, we evaluated the association between sex and CKD awareness, adjusting for potential confounders including age, race/ethnicity and comorbidities. We stratified CKD awareness by 5 pre-defined calendar-year periods and conducted all analyses for the complete study population as well as the Caucasian and African American subpopulations. We found that among 101871 US persons participating in NHANES, 4411 (2232 women) had CKD in stages G3-G5. These participants were, on average, 73±10 years old, 25.3% reported diabetes, 78.0% reported hypertension or had elevated blood pressure during medical examinations and 39.8% were obese (percentages were survey-weighted). CKD awareness was more prevalent among those with higher CKD stage, younger age, diabetes, hypertension and higher body mass index. CKD awareness was generally low (<22.5%), though it increased throughout the study period, remaining consistently higher among men compared to women, with a decreasing gender gap over time (adjusted odds ratio [men-to-women] for CKD awareness = 2.71 [1.31–5.64] in period 1; = 1.32 [0.82–2.12] in period 5). The sex difference in CKD awareness was smaller in African American participants, in whom CKD awareness was generally higher. Using serum creatinine rather than eGFR as the CKD-defining exposure, CKD awareness increased with rising serum creatinine, in a close to identical fashion among both sexes during 1999–2008, while during 2009–2018, CKD awareness among women increased earlier than among men (i.e. with lower serum creatinine levels). Conclusions CKD awareness is lower among US women than men. The narrowing gap between the sexes in more recent years and the results on CKD awareness by serum creatinine indicate that health care professionals have previously been relying on serum creatinine to inform patients about their condition, but in more recent years have been using eGFR, which accounts for women’s lower serum creatinine levels due to their lower muscle mass. Additional efforts should be made to increase CKD awareness among both sexes.

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“…HD is the major treatment modality for RRT worldwide, and it is also the one with the highest mortality rates, followed by kidney transplantation and peritoneal dialysis [ 4 , 10 , 11 ]. For these reasons, one of the most worrying outcomes of CKD is ESRD, in which there is a need for RRT.…”

Section: Introductionmentioning

confidence: 99%

Survival and analysis of predictors of mortality in patients undergoing replacement renal therapy: a 20-year cohort

et al. 2020

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Background optimal management of end-stage renal disease (ESRD) in hemodialysis (HD) patients should be more studied because it is a serious risk factor for mortality, being considered an unquestionable global priority. Methods we performed a retrospective cohort study from the Nephrology Service in Brazil evaluating the survival of patients with ESRD in HD during 20 years. Kaplan-Meier method with the Log-Rank and Cox’s proportional hazards model explored the association between survival time and demographic factors, quality of treatment and laboratory values. Results Data from 422 patients were included. The mean survival time was 6.79 ± 0.37. The overall survival rates at first year was 82,3%. The survival time correlated significantly with clinical prognostic factors. Prognostic analyses with the Cox proportional hazards regression model and Kaplan-Meier survival curves further identified that leukocyte count (HR = 2.665, 95% CI: 1.39–5.12), serum iron (HR = 8.396, 95% CI: 2.02–34.96), serum calcium (HR = 4.102, 95% CI: 1.35–12.46) and serum protein (HR = 4.630, 95% CI: 2.07–10.34) as an independent risk factor for the prognosis of survival time, while patients with chronic obstructive pyelonephritis (HR = 0.085, 95% CI: 0.01–0.74), high ferritin values (HR = 0.392, 95% CI: 0.19–0.80), serum phosphorus (HR = 0.290, 95% CI: 0.19–0.61) and serum albumin (HR = 0.230, 95% CI: 0.10–0.54) were less risk to die. Conclusion survival remains low in the early years of ESRD treatment. The present study identified that elevated values of ferritin, serum calcium, phosphorus, albumin, leukocyte, serum protein and serum iron values as a useful prognostic factor for the survival time.

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Sex-specific analysis of haemodialysis prevalence, practices and mortality over time: the Austrian Dialysis Registry from 1965 to 2014

Cited by 20 publications

References 33 publications

Sex Differences in Kidney Replacement Therapy Initiation and Maintenance

Sex Differences in Kidney Replacement Therapy Initiation and Maintenance

Sex differences in chronic kidney disease awareness among US adults, 1999 to 2018

Survival and analysis of predictors of mortality in patients undergoing replacement renal therapy: a 20-year cohort

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