Abstract: TH-PO720
Survival Advantage of Renal Transplantation over Dialysis Is Blunted in Women
Session Information
- Women's Health and Kidney Diseases
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Women’s Health and Kidney Diseases
- 2000 Women’s Health and Kidney Diseases
Authors
- Sapoznikov, Dan, Hadassah Hebrew University Medical Center, Jerusalem, Israel
- Dranitzki Elhalel, Michal, Hadassah Hebrew University Medical Center, Jerusalem, Israel
- Rubinger, Dvora, Hadassah Hebrew University Medical Center, Jerusalem, Israel
Background
The effect of gender on long term outcome in end stage renal disease is not well defined. Decreased LFα, a baroreflex index, and increased sdSV (stroke volume variability, a measure of myocardial responsiveness) were shown to predict poor prognosis in hemodialysis (HD) patients.
Methods
To assess factors associated with long term survival, clinical data and death events were monitored in 126 men (M) and 70 women (F) on HD and after renal transplantation (TX) during a follow up of 60 months. Continuous interbeat interval (IBI) and systolic blood pressure (SBP) and their variabilities were recorded using Finometer. LFα and sdSV were calculated from SBP and IBI spontaneous variations.
Results
Kaplan-Meier analysis showed a similar (76%) 5 yr survival in HD M and F. A significantly increased survival was noted in TX M compared with HD M (91%, p=0.031) while no such difference was noted in TX F (Figure1). Main death risk factors, LF α and sdSV are shown in Table 1. Age range, the prevalence of diabetes mellitus, hyperlipidemia and HD vintage were similar in M and F.TX was associated with improved blood pressure in all patients. Renal function was similar in TX M and F.
Conclusion
Our data show that despite higher comorbidity prevalence, TX significantly improved survival in M. The enhanced survival in TX M was associated with increased LFα and decreased sdSV, suggesting improved autonomic function. In F no significant changes in these measures were found and the survival benefit of TX was less prominent. The causes of the reduced effect of TX in F remain to be determined.
Table 1.
| n | HD M (75) | HD F (44) | p | TX M (51) | TX F (26) | p |
| Hypertension [n(%)] | 71 (95) | 36 (82) | 0.025 | 46 (92) | 21 (81) | 0.151 |
| Ischemic heart disease [n(%)] | 44 (59) | 22 (50) | 0.358 | 19 (38) | 3 (12) | 0.016 |
| Smoking [n(%)] | 38 (51) | 7 (16) | 0.001 | 19 (38) | 0 (0) | 0.001 |
| LF α (ms/mmHg)* # | 3.44 (2.80) | 3.44 (2.80) | 0.573 | 3.87 (4.00)^ | 4.15 (4.10) | 0.249 |
| sdSV (ml)# | 6.65 (2.80) | 5.40 (2.30) | 0.016 | 4.92 (2.50)^^ | 4.78 (2.30) | 0.914 |
* Square root of average IBI and SBP powers in the low frequency (LF) range. # Median and interquartile ranges. p vs. HD M:^0.003;^^0.001:
Figure 1.