Women at higher risk of all-cause mortality in first 5 years after starting dialysis
Click Here to Manage Email Alerts
Compared with men, women are at a higher risk of all-cause mortality in the first 5 years following dialysis initiation, according to data published in the American Journal of Kidney Diseases.
Further, the two most common causes of death among patients with kidney disease regardless of sex were CVD and dialysis withdrawal.
“Although prior studies have examined the effects of age and era on the survival trends in patients with kidney failure relative to the general population, data relating to the potential interactive effects between sex and patient characteristics, such as age, ethnicity and era of commencing dialysis on cause-specific death in incident dialysis patients with kidney failure, remain unknown,” Wai H. Lim, PhD, from the department of renal medicine at Sir Charles Gairdner Hospital in Australia, and colleagues wrote. They added, “As sex is already identified as a major risk factor for all-cause death in patients with kidney failure, this study aimed to assess the relationship between sex and cause-specific mortality in incident dialysis patients, and to determine the interactions between era, age gradient, ethnicity and sex on cause-cause deaths.”
In a retrospective cohort study, researchers examined data for 53,414 patients (39% were women) who had initiated dialysis in Australia and New Zealand between 1998 and 2018.
Data were derived from the Australia and New Zealand Dialysis and Transplant registry, and researchers followed patients from the commencement of dialysis until kidney transplantation, death on dialysis or Dec. 31, 2018, whichever came first.
Researchers considered the primary outcomes of the study to be cause-specific mortality of cardiovascular-related, infection-related and dialysis withdrawal-related mortality on dialysis. Using cause-specific proportional hazards models, researchers measured the associations between sex, cause-specific and all-cause mortality while focusing on the first 5 years following initiation of dialysis.
After a median of 2.8 years follow-up, 51% of the patients died. Researchers identified the two most common causes of death as CVD (18%), followed by dialysis withdrawal (16%). Analyses revealed women were more likely to die in the first 5 years after dialysis initiation compared with men. While women experienced a lower risk of CVD-related mortality compared with men, they experienced a greater risk of infection-related and dialysis withdrawal-related mortality.
“Our study findings are particularly important as this may form the focus of future studies and targeted policies designed to reduce the survival disparity in female patients with kidney failure. However, it is essential to examine whether the sex differences in cause-specific mortality are apparent in other countries with dissimilar health care structures and resources, which may then provide additional insight into the explanation contributing to this difference in health outcomes among dialysis patients,” Lim and colleagues wrote. “Research addressing the sex-disparities in the pattern and contributing factors of cause-specific mortality in patients with kidney failure remains inadequate but is critical to delineating clear evidence relating to the benefit of targeted interventions to improve health outcomes in this population.”
Collapse
Read more about
Click Here to Manage Email Alerts