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Abstract: FR-PO800

Gender Differences in Three-Year Clinical Outcomes in Japanese Dialysis Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Morinaga, Takatoshi, Anjo Kosei Hospital , Aichi prefecture Anjo city, Japan
  • Fukatsu, Atsushi, Fukatsu Medical Clinic, Anjo, Japan
  • Inaguma, Daijo, Fujita Health University School of Medicine, Toyoake, Japan
  • Tamai, Hirofumi, Anjo Kosei Hospital , Aichi prefecture Anjo city, Japan
Background

A recent Dialysis Outcomes and Practice Patterns Study (DOPPS) has shown a male-to-female mortality ratio one-to-one, notwithstanding women's statistically longer life expectancy in the general population (Hecking et al., 2014). This finding contrasts with the recent report that Japanese women on dialysis treatment have more favorable longevity (Jap. Soc. Dial. Ther., 2009). Accordingly, we further investigated clinical procedures and outcomes in order to clarify the gender differences in Japanese patients on chronic dialysis treatment in order to establish an optimal dialysis modality.

Methods

Subjects were patients in 17 centers participating in the Aichi Cohort Study of Prognosis in Patients Newly Initiated into Dialysis (AICOPP) from October 2011 to September 2013. We excluded 129 from the study because their three-year outcome data was unavailable. Thus, 1,395 subjects were enrolled in the study. Three-year mortality was analyzed by multivariate logistic regression model adjusted by age, gender, body mass index (BMI), diabetes mellitus, C-reactive protein, serum albumin, use of statin, history of cardiovascular disease (CVD) and malignancy. Three-year mortality and CVD events were studied separately in women and men with or without CVD at baseline.

Results

Overall, 458 (32.4%) of 1,395 test subjects were women. Women had lower rates of diabetes mellitus (Women 49.8% vs Men 56.0: P=0.028) and history of CVD (38.2% vs 49.8: P<0.001). Age (mean ± SD, 68.2 year ± 12.7 vs 67.7 ± 12.8: P=0.51) and BMI (23.3 ± 5.3 vs 23.5 ± 3.9: P=0.30) were similar in both sexes. Female gender (adjusted odds ratio 0.66: 95% CI 0.47-0.91) was a positive and history of CVD (OR 1.85: 1.37-2.51) was a negative independent predictor of three-year mortality.

Conclusion


Women on chronic dialysis treatment had a lower mortality risk than men. However, women with CVD comorbidity had a higher mortality rate which cancelled out the survival advantage. These data suggest that the dialysis modality for women with a risk of CVD needs to be modified.

Three-year outcome in subgroups (N=1395)
 Women CVD+ N=175Women CVD- N=283Men CVD+ N=467Men CVD- N=470P value
Age year: Mean (SD)71.5 (11.3)66.2 (13.2)70.6 (11.6)64.9 (13.3)0.05
All-cause mortality: N (%)50 (28.6)26 (9.2)140 (30.0)83 (17.7)<0.001
CVD mortality: N (%)31 (17.9)11 (3.9)75 (16.4)35 (7.5)<0.001
Cardiac mortality: N (%)26 (15.0)9 (3.2)53 (11.6)29 (6.2)<0.001
CVD event: N (%)69 (43.1)43 (15.8)201 (48.8)107 (24.9)<0.001