Sex-Specific Differences in Hemodialysis Prevalence and Practices and the Male-to-Female Mortality Rate: The Dialysis Outcomes and Practice Patterns Study (DOPPS)

English version České info

Background:
A comprehensive analysis of sex-specific differences in the characteristics, treatment, and outcomes of individuals with end-stage renal disease undergoing dialysis might reveal treatment inequalities and targets to improve sex-specific patient care. Here we describe hemodialysis prevalence and patient characteristics by sex, compare the adult male-to-female mortality rate with data from the general population, and evaluate sex interactions with mortality.

Methods and Findings:
We assessed the Human Mortality Database and 206,374 patients receiving hemodialysis from 12 countries (Australia, Belgium, Canada, France, Germany, Italy, Japan, New Zealand, Spain, Sweden, the UK, and the US) participating in the international, prospective Dialysis Outcomes and Practice Patterns Study (DOPPS) between June 1996 and March 2012. Among 35,964 sampled DOPPS patients with full data collection, we studied patient characteristics (descriptively) and mortality (via Cox regression) by sex. In all age groups, more men than women were on hemodialysis (59% versus 41% overall), with large differences observed between countries. The average estimated glomerular filtration rate at hemodialysis initiation was higher in men than women. The male-to-female mortality rate ratio in the general population varied from 1.5 to 2.6 for age groups <75 y, but in hemodialysis patients was close to one. Compared to women, men were younger (mean = 61.9±standard deviation 14.6 versus 63.1±14.5 y), were less frequently obese, were more frequently married and recipients of a kidney transplant, more frequently had coronary artery disease, and were less frequently depressed. Interaction analyses showed that the mortality risk associated with several comorbidities and hemodialysis catheter use was lower for men (hazard ratio [HR] = 1.11) than women (HR = 1.33, interaction p<0.001). This study is limited by its inability to establish causality for the observed sex-specific differences and does not provide information about patients not treated with dialysis or dying prior to a planned start of dialysis.

Conclusions:
Women's survival advantage was markedly diminished in hemodialysis patients. The finding that fewer women than men were being treated with dialysis for end-stage renal disease merits detailed further study, as the large discrepancies in sex-specific hemodialysis prevalence by country and age group are likely explained by factors beyond biology. Modifiable variables, such as catheter use, showing significant sex interactions suggest interventional targeting.

Please see later in the article for the Editors' Summary

Vyšlo v časopise: Sex-Specific Differences in Hemodialysis Prevalence and Practices and the Male-to-Female Mortality Rate: The Dialysis Outcomes and Practice Patterns Study (DOPPS). PLoS Med 11(10): e32767. doi:10.1371/journal.pmed.1001750
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pmed.1001750

Souhrn

Zdroje

1. Putting gender on the agenda. Nature 465: 665 doi:10.1038/465665a

2. ArnoldK (2000) Journal to encourage analysis by sex/ethnicity. J Natl Cancer Inst 92: 1561.

3. Taking sex into account in medicine. Lancet 378: 1826 doi:10.1016/S0140-6736(11)61795-9

4. HaslamDW, JamesWP (2005) Obesity. Lancet 366: 1197–1209.

5. MeisingerC, ThorandB, SchneiderA, StieberJ, DoringA, et al. (2002) Sex differences in risk factors for incident type 2 diabetes mellitus: the MONICA Augsburg cohort study. Arch Intern Med 162: 82–89.

6. PerreaultL, MaY, Dagogo-JackS, HortonE, MarreroD, et al. (2008) Sex differences in diabetes risk and the effect of intensive lifestyle modification in the Diabetes Prevention Program. Diabetes Care 31: 1416–1421.

7. HuxleyVH (2007) Sex and the cardiovascular system: the intriguing tale of how women and men regulate cardiovascular function differently. Adv Physiol Educ 31: 17–22.

8. SaffordMM, BrownTM, MuntnerPM, DurantRW, GlasserS, et al. (2012) Association of race and sex with risk of incident acute coronary heart disease events. JAMA 308: 1768–1774.

9. PiccinelliM, WilkinsonG (2000) Gender differences in depression. Critical review. Br J Psychiatry 177: 486–492.

10. AbrassCK (2004) Overview: obesity: what does it have to do with kidney disease? J Am Soc Nephrol 15: 2768–2772.

11. ZhangQL, RothenbacherD (2008) Prevalence of chronic kidney disease in population-based studies: systematic review. BMC Public Health 8: 117.

12. CoreshJ, Byrd-HoltD, AstorBC, BriggsJP, EggersPW, et al. (2005) Chronic kidney disease awareness, prevalence, and trends among U.S. adults, 1999 to 2000. J Am Soc Nephrol 16: 180–188.

13. CarreroJJ, de JagerDJ, VerduijnM, RavaniP, De MeesterJ, et al. (2011) Cardiovascular and noncardiovascular mortality among men and women starting dialysis. Clin J Am Soc Nephrol 6: 1722–1730.

14. YoungEW, GoodkinDA, MapesDL, PortFK, KeenML, et al. (2000) The Dialysis Outcomes and Practice Patterns Study (DOPPS): an international hemodialysis study. Kidney Int 57: S74–S81.

15. PisoniRL, GillespieBW, DickinsonDM, ChenK, KutnerMH, et al. (2004) The Dialysis Outcomes and Practice Patterns Study (DOPPS): design, data elements, and methodology. Am J Kidney Dis 44: 7–15.

16. LeveyAS, StevensLA, SchmidCH, ZhangYL, CastroAF3rd, et al. (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150: 604–612.

17. University of California at Berkeley, Max Planck Institute for Demographic Research (2014) The Human Mortality Database [database]. Available: http://www.mortality.org/. Accessed 3 July 2014.

18. Wilmoth JR, Andreev K, Jdanov D, Glie DA (2007) Methods protocol for the Human Mortality Database, version 5. Available: http://www.mortality.org/Public/Docs/MethodsProtocol.pdf. Accessed 25 September 2014.

19. McDonald S, Hurst K, editors (2011) The thirty fourth annual ANZDATA report 2011. Adelaide (Australia): Australia and New Zealand Dialysis and Transplant Registry.

20. Canadian Institute for Health Information (2011) Canadian Organ Replacement Register annual report: treatment of end-stage organ failure in Canada, 2001 to 2010. Available: https://secure.cihi.ca/free_products/2011_CORR_Annua_Report_EN.pdf. Accessed 23 September 2014.

21. NakaiS, IsekiK, ItamiN, OgataS, KazamaJJ, et al. (2012) An overview of regular dialysis treatment in Japan (as of 31 December 2010). Ther Apher Dial 16: 483–521.

22. European Renal Association–European Dialysis and Transplant Association (2013) ERA-EDTA Registry: annual report 2011. Amsterdam: Academic Medical Center Department of Medical Informatics.

23. United States Renal Data System (2013) USRDS 2013 annual data report: atlas of chronic kidney disease and end-stage renal disease in the United States. Bethesda (Maryland): National Institutes of Health National Institute of Diabetes and Digestive and Kidney Diseases.

24. Raghunathan TE, Solenberger PW, Van Hoewyk J (2002) IVEware: imputation and variance estimation software [computer program]. Ann Arbor (Michigan): Survey Methodology Program, Survey Research Center, Institute for Social Research, University of Michigan.

25. von ElmE, AltmanDG, EggerM, PocockSJ, GøtzschePC, et al. (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med 147: 573–577.

26. McCulloughK, SharmaP, AliT, KhanI, SmithWC, et al. (2012) Measuring the population burden of chronic kidney disease: a systematic literature review of the estimated prevalence of impaired kidney function. Nephrol Dial Transplant 27: 1812–1821.

27. NeugartenJ, AcharyaA, SilbigerSR (2000) Effect of gender on the progression of nondiabetic renal disease: a meta-analysis. J Am Soc Nephrol 11: 319–329.

28. EriksenBO, IngebretsenOC (2006) The progression of chronic kidney disease: a 10-year population-based study of the effects of gender and age. Kidney Int 69: 375–382.

29. VerhaveJC, HillegeHL, BurgerhofJG, NavisG, de ZeeuwD, et al. (2003) Cardiovascular risk factors are differently associated with urinary albumin excretion in men and women. J Am Soc Nephrol 14: 1330–1335.

30. FaruqueLI, HemmelgarnBR, WiebeN, MannsBJ, RavaniP, et al. (2013) Factors associated with initiation of chronic renal replacement therapy for patients with kidney failure. Clin J Am Soc Nephrol 8: 1327–1335.

31. Kautzky-WillerA, DornerT, JensbyA, RiederA (2012) Women show a closer association between educational level and hypertension or diabetes mellitus than males: a secondary analysis from the Austrian HIS. BMC Public Health 12: 392.

32. VeronesiG, FerrarioMM, ChamblessLE, SegaR, ManciaG, et al. (2011) Gender differences in the association between education and the incidence of cardiovascular events in northern Italy. Eur J Public Health 21: 762–767.

33. KauszAT, ObradorGT, AroraP, RuthazerR, LeveyAS, et al. (2000) Late initiation of dialysis among women and ethnic minorities in the United States. J Am Soc Nephrol 11: 2351–2357.

34. CrewsDC, SciallaJJ, LiuJ, GuoH, Bandeen-RocheK, et al. (2014) Predialysis health, dialysis timing, and outcomes among older United States adults. J Am Soc Nephrol 25: 370–379.

35. SlininY, GuoH, LiS, LiuJ, MorganB, et al. (2014) Provider and care characteristics associated with timing of dialysis initiation. Clin J Am Soc Nephrol 9: 310–317.

36. LiY, KapkeA, JinY, PearsonJ, PortFK, et al. (2013) Estimated GFR at dialysis initiation: associations with clinical and non-clinical factors [abstract]. Kidney Week 2013; 5–10 November 2013; Atlanta, Georgia, US. Abstract SA-PO516. J Am Soc Nephrol 24 (Suppl) 745A.

37. IsekiK, IsekiC, IkemiyaY, FukiyamaK (1996) Risk of developing end-stage renal disease in a cohort of mass screening. Kidney Int 49: 800–805.

38. GoAS, ChertowGM, FanD, McCullochCE, HsuCY (2004) Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 351: 1296–1305.

39. VillarE, RemontetL, LabeeuwM, EcochardR (2007) Effect of age, gender, and diabetes on excess death in end-stage renal failure. J Am Soc Nephrol 18: 2125–2134.

40. CarreroJJ, de MutsertR, AxelssonJ, DekkersOM, JagerKJ, et al. (2011) Sex differences in the impact of diabetes on mortality in chronic dialysis patients. Nephrol Dial Transplant 26: 270–276.

41. LeeWL, CheungAM, CapeD, ZinmanB (2000) Impact of diabetes on coronary artery disease in women and men: a meta-analysis of prospective studies. Diabetes Care 23: 962–968.

42. JousilahtiP, VartiainenE, TuomilehtoJ, PuskaP (1999) Sex, age, cardiovascular risk factors, and coronary heart disease: a prospective follow-up study of 14 786 middle-aged men and women in Finland. Circulation 99: 1165–1172.

43. JuutilainenA, KortelainenS, LehtoS, RonnemaaT, PyoralaK, et al. (2004) Gender difference in the impact of type 2 diabetes on coronary heart disease risk. Diabetes Care 27: 2898–2904.

44. LeaveySF, McCulloughK, HeckingE, GoodkinD, PortFK, et al. (2001) Body mass index and mortality in ‘healthier’ as compared with ‘sicker’ haemodialysis patients: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrol Dial Transplant 16: 2386–2394.

45. Kalantar-ZadehK, AbbottKC, SalahudeenAK, KilpatrickRD, HorwichTB (2005) Survival advantages of obesity in dialysis patients. Am J Clin Nutr 81: 543–554.

46. FoleyRN, ParfreyPS, SarnakMJ (1998) Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis 32: S112–S119.

47. SarnakMJ, LeveyAS, SchoolwerthAC, CoreshJ, CulletonB, et al. (2003) Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Circulation 108: 2154–2169.

48. HerzogCA, MaJZ, CollinsAJ (1998) Poor long-term survival after acute myocardial infarction among patients on long-term dialysis. N Engl J Med 339: 799–805.

49. RamirezSP, KapkeA, PortFK, WolfeRA, SaranR, et al. (2012) Dialysis dose scaled to body surface area and size-adjusted, sex-specific patient mortality. Clin J Am Soc Nephrol 7: 1977–1987.

50. YoshinoM, KuhlmannMK, KotankoP, GreenwoodRN, PisoniRL, et al. (2006) International differences in dialysis mortality reflect background general population atherosclerotic cardiovascular mortality. J Am Soc Nephrol 17: 3510–3519.

51. PoundsLL, TeodorescuVJ (2013) Chronic kidney disease and dialysis access in women. J Vasc Surg 57 (Suppl 4) 49S–53S.e1.

52. MillerCD, RobbinML, AllonM (2003) Gender differences in outcomes of arteriovenous fistulas in hemodialysis patients. Kidney Int 63: 346–352.

53. WasseH, HopsonSD, McClellanW (2010) Racial and gender differences in arteriovenous fistula use among incident hemodialysis patients. Am J Nephrol 32: 234–241.

54. CaplinN, SedlacekM, TeodorescuV, FalkA, UribarriJ (2003) Venous access: women are equal. Am J Kidney Dis 41: 429–432.

55. CarreroJJ (2010) Gender differences in chronic kidney disease: underpinnings and therapeutic implications. Kidney Blood Press Res 33: 383–392.

56. ShenoyS (2009) Surgical anatomy of upper arm: what is needed for AVF planning. J Vasc Access 10: 223–232.

57. SaranR, ElderSJ, GoodkinDA, AkibaT, EthierJ, et al. (2008) Enhanced training in vascular access creation predicts arteriovenous fistula placement and patency in hemodialysis patients: results from the Dialysis Outcomes and Practice Patterns Study. Ann Surg 247: 885–891.

58. AstorBC, EustaceJA, PoweNR, KlagMJ, FinkNE, et al. (2005) Type of vascular access and survival among incident hemodialysis patients: the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) Study. J Am Soc Nephrol 16: 1449–1455.

59. KenfieldSA, StampferMJ, RosnerBA, ColditzGA (2008) Smoking and smoking cessation in relation to mortality in women. JAMA 299: 2037–2047.

60. JohnsonNJ, BacklundE, SorliePD, LovelessCA (2000) Marital status and mortality: the national longitudinal mortality study. Ann Epidemiol 10: 224–238.

61. PrinceM, PatelV, SaxenaS, MajM, MaselkoJ, et al. (2007) No health without mental health. Lancet 370: 859–877.

62. LopesAA, AlbertJM, YoungEW, SatayathumS, PisoniRL, et al. (2004) Screening for depression in hemodialysis patients: associations with diagnosis, treatment, and outcomes in the DOPPS. Kidney Int 66: 2047–2053.

63. GargPP, FurthSL, FivushBA, PoweNR (2000) Impact of gender on access to the renal transplant waiting list for pediatric and adult patients. J Am Soc Nephrol 11: 958–964.

64. Controlling the epidemic of cardiovascular disease in chronic renal disease: What do we know? What do we need to know? Where do we go from here? Special report from the National Kidney Foundation Task Force on Cardiovascular Disease. Am J Kidney Dis 32: S1–S199.