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Cardiovascular and noncardiovascular mortality among men and women starting dialysis
Juan J Carrero1, Dinanda J de Jager, Marion Verduijn
1Division of Renal Medicine, Centre for Molecular Medicine and Centre for Gender Medicine, Karolinska Institutet, Stockholm, Sweden. Juan.Jesus.Carrero@ki.se
Insights
Women on dialysis lose their survival advantage, experiencing higher noncardiovascular mortality, particularly young and diabetic women. This increased risk negates the typical female survival benefit observed in the general population.
Area of Science:
- Nephrology and Cardiovascular Epidemiology
- Sex-Based Differences in Health Outcomes
Background:
- Women typically exhibit a survival advantage over men in the general population.
- However, women undergoing dialysis have comparable mortality rates to men, suggesting a loss of this advantage.
Purpose of the Study:
- To investigate the hypothesis that a relative excess of cardiovascular-related mortality in women explains their similar mortality risk to men on dialysis.
- To analyze age-stratified cardiovascular and noncardiovascular mortality in dialysis patients compared to the general population.
Main Methods:
- A European cohort of incident adult dialysis patients (ERA-EDTA Registry) was compared with the European general population (Eurostat).
- Five-year age-stratified mortality rates, relative risks, and hazard ratios for cardiovascular and noncardiovascular causes were analyzed.
- Causes of death were classified using ERA-EDTA and International Statistical Classification of Diseases codes.
Main Results:
- Overall sex did not predict outcomes in dialysis patients.
- Younger women (<45 years) had higher noncardiovascular mortality.
- Older women (>45 years) had lower cardiovascular mortality than men, but this benefit was less pronounced than in the general population.
- Diabetic women across all age groups showed increased mortality risk compared to men, primarily due to noncardiovascular causes.
Conclusions:
- Mortality patterns and causes of death in dialysis patients differ between sexes and vary with age.
- Increased noncardiovascular mortality in women on dialysis contributes to the loss of their survival advantage.
- Young and diabetic women initiating dialysis face a higher mortality risk than their male counterparts.
Background And Objectives:
Although women have a survival advantage in the general population, women on dialysis have similar mortality to men. We hypothesized that this paired mortality risk during dialysis may be explained by a relative excess of cardiovascular-related mortality in women.
Design, Setting, Participants, & Measurements:
We compared 5-year age-stratified cardiovascular and noncardiovascular mortality rates, relative risks, and hazard ratios in a European cohort of incident adult dialysis patients (European Renal Association-European Dialysis and Transplant Association [ERA-EDTA] Registry) with the European general population (Eurostat). Cause of death was recorded by ERA-EDTA codes in dialysis patients and by International Statistical Classification of Diseases codes in the general population.
Results:
Overall, sex did not have a predictive effect on outcome in dialysis. Stratification into age categories and causes of death showed greater noncardiovascular mortality in young women (<45 years). In other age categories (45 to 55 and >55 years), women presented lower cardiovascular mortality. This cardiovascular benefit was, however, smaller than in the general population. Stratification by diabetic nephropathy showed that diabetic women in all age categories remained at increased mortality risk compared with men, an effect mainly attributed to the noncardiovascular component.
Conclusions:
Mortality rates and causes of death in men and women on dialysis vary with age. Increased noncardiovascular mortality may explain the loss of the survival advantage of women on dialysis. Both young and diabetic women starting dialysis are at a higher mortality risk than equal men.
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