Sex-Specific Differences in Hemodialysis Prevalence and Practices and the Male-to-Female Mortality Rate: The Dialysis Outcomes and Practice Patterns Study (DOPPS)

Hecking, Manfred; Bieber, Brian; Éthier, Jean; Kautzky‐Willer, Alexandra; Sunder‐Plassmann, Gere; Säemann, Marcus D.; Ramirez, Sylvia; Gillespie, Brenda W.; Pisoni, Ronald L.; Robinson, Bruce M.; Port, Friedrich K.

doi:10.1371/journal.pmed.1001750

Cited by 226 publications

(270 citation statements)

References 59 publications

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“…The median follow-up time was 1.7 years. A link to higher catheter-related mortality risk for women was proposed and the question was raised whether men and women differ in dialysis initiation and chronic kidney disease care, which might impact the survival [15]. Our study is in line with these findings and expands them to a follow-up period of more than 10 years.…”

Section: Discussionsupporting

confidence: 79%

Long-Term Survivor Characteristics in Hemodialysis Patients with Type 2 Diabetes

et al. 2018

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Background: Data concerning long-term mortality predictors among large, purely diabetic hemodialysis collectives are scarce. Methods: We used data from a multicenter, prospective, randomized trial among 1,255 hemodialysis patients with type 2 diabetes mellitus (T2DM) and its observational follow-up study. The association of 10 baseline candidate variables with mortality was assessed by Cox proportional hazards regression. Results: Overall, 103 participants survived the median follow-up of 11.5 years. Significant predictors of mortality were age (hazard ratio [HR] 1.03, 95% CI 1.02–1.04), cardiovascular (HR 1.42, 95% CI 1.25–1.62) and peripheral vascular disease (HR 1.55, 95% CI 1.36–1.76), higher hemoglobin A1c (HbA1c; HR 1.08, 95% CI 1.03–1.14), and loss of self-dependency (HR 1.20, 95% CI 1.03–1.39). Higher albumin (HR 0.72, 95% CI 0.59–0.89) and body mass index (BMI; HR 0.98, 95% CI 0.96–0.99) had protective associations. There was no significant association with sex, diabetes duration, and cerebrovascular diseases. Subgroup analyses by age and diabetes duration showed stronger associations of cardiovascular disease, HbA1c, albumin, BMI, and loss of self-dependency in younger patients and/or shorter diabetes duration. Loss of self-dependency and energy resources (albumin, BMI) increased mortality more severely in women, whilst the impact of cardiovascular and peripheral vascular diseases was more pronounced in men. Conclusion: Long-term mortality risk in patients with T2DM on hemodialysis was associated with higher age, vascular diseases, HbA1c, loss of self-dependency, and low energy resources. Interestingly, it does not vary between sexes. Further individualized prognosis estimation and therapy should strongly depend on age, diabetes duration, and gender.

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Section: Discussionsupporting

confidence: 79%

Long-Term Survivor Characteristics in Hemodialysis Patients with Type 2 Diabetes

et al. 2018

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“…Moreover, our participants were relatively young, and more than half were male. This male predominance in the HD population is a global finding [32] and is consistent with "The Dialysis Outcomes and Practice Patterns Study"…”

Section: N (%) N (%)supporting

confidence: 82%

Intradialytic Aerobic Exercise in the United Arab Emirates: a Descriptive Study

Salhab

Karavetian

Kooman

et al. 2018

AJNE

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Aim. Intradialytic exercise (IDE) improves hyperphosphatemia management in hemodialysis (HD) patient in addition to other clinical outcomes. The aim of the study is to present the strategies needed to integrate such a protocol in an HD unit in UAE and patients' baseline characteristics. Methods. The largest HD unit in Sharjah emirate was chosen. All eligible patients (n = 57) in the unit were included. Patients were stable adults HD patients who served as their own controls. The intervention included an aerobic low intensity IDE of 45 minutes per HD session, tailored to each patient's fitness scale (BORG scale) for 6 months. Patients were educated on the importance of exercise. Outcome measures were barriers to exercise, serum phosphorus (P), urea reduction ratio (URR), malnutrition inflammation score, quality of life (QOL using euroqol5) collected at baseline and post intervention. Results. A total of 41 patients completed the study, 61% were males and 90.2%, 53.7% and 14.6% suffered from hypertension, diabetes and cardiovascular disease, respectively. Hyperphosphatemia was prevalent among 75% of the patients with a mean of 5.76 ± 1.66 mg/dl. The mean age was 48 ± 14.37 years, BMI 24.98 ± 6.09 kg/m 2 , URR 71.88 ± 8.52%, and Kt/v 1.32 ± 1.09.The main barrier to exercise was identified to be fatigue on HD days by 58.5% of patients, followed by fear of getting hurt (36.6%). Finally, 80.4% of patients were mildly malnourished and QOL scale was 65.02% ± 18.54. Conclusion. Our study highlighted the widespread of hyperphosphatemia and malnutrition in our sample. The IDE regimen, if proven effective in future studies, could be integrated in the routine practice and may improve patients'outcomes.

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“…The association between gender and survival may differ across age groups, although somewhat controversial [22]. A study based on the Canadian Organ Replacement Registry investigated associations between gender and all-cause mortality across age groups in a cohort of 28,971 incident chronic hemodialysis patients.…”

Section: Differences In Clinical Outcomesmentioning

confidence: 99%

The characteristics of the older dialysis population—heterogeneity and another type of altered risk factor patterns

2017

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The number of older dialysis patients is increasing in many countries. For example, the trend is linked to the increase in the dialysis patients 70 years of age and over in Japan. Older dialysis patients often experience deteriorating physical and psychological functions, and special consideration for older patients has been focused on improving or preventing such deteriorations. On the other hand, from the standpoint of clinical studies, the distribution of clinical parameters, clinical outcomes, and their associations of older dialysis patients differ from those of younger patients. Moreover, they exhibit heterogeneous phenotypes. Health age may be more important than the chronological age in considering older patients. Since the age is the most powerful predictor of survival, clinical interventions might have little benefit on the very old dialysis patients. Therefore, maintaining the quality of life or activity of daily living might surpass survival regarding the goal of management of very old dialysis patients. Above all, individualized management according to the heterogeneity or health age are necessary for the older dialysis patients. Future clinical studies of older dialysis patients are needed for the better understanding of this population.

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Sex-Specific Differences in Hemodialysis Prevalence and Practices and the Male-to-Female Mortality Rate: The Dialysis Outcomes and Practice Patterns Study (DOPPS)

Cited by 226 publications

References 59 publications

Long-Term Survivor Characteristics in Hemodialysis Patients with Type 2 Diabetes

Long-Term Survivor Characteristics in Hemodialysis Patients with Type 2 Diabetes

Intradialytic Aerobic Exercise in the United Arab Emirates: a Descriptive Study

The characteristics of the older dialysis population—heterogeneity and another type of altered risk factor patterns

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