Related Experiment Video
Updated: Jun 27, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Sex Differences in Cardiovascular Outcomes in Patients With Kidney Failure
Silvi Shah1, Annette L Christianson2, Karthikeyan Meganathan2
1Division of Nephrology and Hypertension, Department of Internal Medicine University of Cincinnati Cincinnati OH USA.
Insights
Women undergoing dialysis face higher risks of heart failure and stroke but have lower mortality rates from cardiovascular causes and all-cause death compared to men. This highlights sex-based differences in cardiovascular outcomes for kidney failure patients.
Area of Science:
- Nephrology
- Cardiology
- Epidemiology
- Sex-based medicine
Background:
- Cardiovascular disease (CVD) is the primary cause of death in patients with kidney failure.
- These patients exhibit a 10-20 fold increased risk of cardiovascular events compared to the general population.
Purpose of the Study:
- To investigate sex-based differences in cardiovascular event risk, cardiovascular death, and all-cause mortality among patients initiating dialysis.
- To analyze the association between sex and specific cardiovascular outcomes including acute coronary syndrome, heart failure, and stroke.
Main Methods:
- Evaluation of 508,822 patients initiating dialysis between 2005 and 2014 using the United States Renal Data System (USRDS) with linked Medicare claims.
- Determination of hospitalization rates for cardiovascular events (acute coronary syndrome, heart failure, stroke).
- Utilized adjusted time-to-event models to examine the association of sex with outcomes.
Main Results:
- Women comprised 44.7% of the study cohort (mean age 70±12 years).
- The overall cardiovascular event rate was 232 per 1000 person-years, higher in women (248) than men (219).
- Women demonstrated a 14% higher risk of cardiovascular events (HR 1.14), 16% higher risk of heart failure (HR 1.16), and 31% higher risk of stroke (HR 1.31), but no difference in acute coronary syndrome risk (HR 1.01).
- Conversely, women had a lower risk of cardiovascular death (HR 0.89) and all-cause death (HR 0.96) compared to men.
Conclusions:
- Among dialysis patients, women experience a greater risk of heart failure and stroke than men.
- Despite higher event rates, women exhibit a lower adjusted risk for both cardiovascular mortality and all-cause mortality.
- Findings underscore significant sex-based disparities in cardiovascular outcomes and mortality within the end-stage renal disease population.
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.
More Related Videos
Related Concept Videos
01:22Heart Failure Drugs: Diuretics
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:17Factors Affecting Renal Clearance: Renal Impairment
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...
01:23Assessment of the Cardiovascular System I: Subjective Data
Initial Enquiry
Ask the patient about their primary concern and thoroughly explore all reported symptoms.
Medical History
Investigate past illnesses affecting the cardiovascular system, such as angina, anemia, rheumatic fever, congenital heart disease, stroke, thrombophlebitis, dysrhythmias, varicosities
Inquire about symptoms...
01:11Renal Failure: Dose Adjustments
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
01:26Imbalances in Cardiac Output
CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send...