Women have a higher risk than men of dying within the first 5 years after dialysis initiation, a recent Australian study finds.
Among 53,414 patients (39% female) who initiated hemodialysis or peritoneal dialysis in the 1998-2018 Australia and New Zealand Dialysis and Transplant registry, 27,137 patients (51%) died during a median follow-up period of 2.8 years. The top causes of death were cardiovascular disease (CVD), including ischemic heart disease, heart failure, or arrhythmia (18%) and dialysis withdrawal (16%) for either psychosocial or medical reasons such as dialysis access difficulties and cancer.
In the first 5 years postdialysis initiation, 50% of women and 48% of men died. CVD was the most common cause of death in both groups (34% and 39%, respectively), followed by dialysis withdrawal (32% and 29%) and infection (12% and 10%).
Compared with men, women had a significant 6% higher risk of death from any cause in the first 5 years after dialysis initiation, Wai H. Lim, MBBS, PhD, of Sir Charles Gairdner Hospital, Perth, Western Australia and colleagues reported in the American Journal of Kidney Diseases. Women had a significant 20% increased risk of infection-related mortality and a significant 19% increased risk of dialysis withdrawal-related mortality.
Women, however, had a significant 7% lower risk of cardiovascular-related mortality overall. “Despite this apparent benefit, it is important to emphasize that up to 1 in 3 female patients with kidney failure die from CVD,” Dr Lim’s team wrote.
The investigators suggested that higher infection-related mortality in women may stem from the effects of female sex hormones on the immune system, higher incidence of autoimmune disorders requiring immunosuppressants, and increased use of central venous catheters for hemodialysis. Women are also more likely than men to opt for conservative care after starting dialysis due to less social support and access to health care.
In a substudy of 13,966 patients who had survived 5 years on dialysis without receiving kidney transplants, 55% of women and 58% of men died, with CVD the predominant cause of death in both groups. Compared with men, women had a significant 18% lower risk for CVD-related death, but the risks for infection-related death, dialysis withdrawal-related death, and death from any cause were similar in both groups.
“Other than a greater emphasis on CVD health preventive strategies in female patients with kidney failure, clinicians must also ensure a greater management focus on infection precautions and provision of social and psychological supports, all of which may ultimately reduce the excess early mortality risks in female patients,” according to Dr Lim’s team.
The study findings on death after dialysis initiation in women vs men reflect an Australian population and might not apply to patients in other countries.
Lim WH, Chen JH, Minas K, et al. Sex disparity in cause-specific and all-cause mortality among incident dialysis patients. Am J Kidney Dis. Published online August 24, 2022. doi:10.1053/j.ajkd.2022.07.007