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Sex differences in clinical outcomes in Japanese incident dialysis patients: a prospective observational multicenter study

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Abstract

Background

A Dialysis Outcomes and Practice Patterns Study (DOPPS) has shown a one-to-one male-to-female mortality ratio, notwithstanding the statistically longer life expectancy of women in the general population. This finding contrasts with the recent report that Japanese women on dialysis treatment have a more favorable longevity. Accordingly, we further investigated the clinical procedures and outcomes to clarify the sex differences in Japanese patients undergoing dialysis treatment.

Methods

Subjects were incident dialysis patients who participated in a multicenter prospective cohort study from October 2011 to September 2013. The all-cause mortality was analyzed by a Cox proportional hazard regression model and studied separately in women and men with or without cardiovascular disease (CVD) at baseline.

Results

Overall, 492 (32.3%) of the 1520 test subjects were women. All-cause mortality was higher in men (28.6%) than in women (19.9%, p < 0.001). Female sex (hazard ratio [HR]: 0.70, 95% confidence interval [CI]: 0.54–0.90) and history of CVD (HR: 1.51, 95% CI: 1.18–1.95) were independent predictors of all-cause mortality. In patients without CVD, female gender was strong independent contributor (HR = 0.46, 95% CI: 0.30–0.70, p < 0.001). In contrast, patients with CVD showed no difference in survival between the sexes (HR: 0.92, 95% CI: 0.67–1.24, p = 0.597).

Conclusion

Our study demonstrated that women undergoing chronic dialysis therapy had a lower mortality risk than men. However, complication with CVD canceled out the survival advantage in Japanese women on chronic dialysis. We should reevaluate the risk of women with CVD undergoing dialysis and apply the optimal care for CVD.

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Authors and Affiliations

  1. Department of Nephrology, Graduate School of Medicine, Nagoya University, Nagoya, Japan

    Yohei Kozaki, Tomoki Kosugi & Shoichi Maruyama

  2. Department of Nephrology, Anjo Kosei Hospital, Anjo, Japan

    Takatoshi Morinaga, Takeshi Ito & Hirofumi Tamai

  3. Fukatsu Medical Clinic, Anjo, Japan

    Atsushi Fukatsu

  4. Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Japan

    Takuji Ishimoto

  5. Department of Internal Medicine, Fujita Health University Bantane Hospital, Nagoya, Japan

    Daijo Inaguma

Authors
  1. Yohei Kozaki
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  2. Takatoshi Morinaga
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  3. Atsushi Fukatsu
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  4. Takeshi Ito
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  5. Takuji Ishimoto
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  6. Tomoki Kosugi
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  7. Daijo Inaguma
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  8. Hirofumi Tamai
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  9. Shoichi Maruyama
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Contributions

YK and TM participated in the design of the study and interpretation of the data. DI surveyed and collected information about prognosis. TM and TI performed the statistical analyses. YK drafted the manuscript, and AF, TI, HT, TK, and SM revised it critically for important intellectual content. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Takatoshi Morinaga.

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Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional research committee at the locations where the studies were conducted (IRB approval number R18-069) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The AICOPP study was registered at the University Hospital Medical Information Network on January 18, 2012 (ID 000007096).

Informed consent

Informed consent was obtained from all recruited individual participants included in the AICOPP study.

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Kozaki, Y., Morinaga, T., Fukatsu, A. et al. Sex differences in clinical outcomes in Japanese incident dialysis patients: a prospective observational multicenter study. Clin Exp Nephrol 26, 466–475 (2022). https://doi.org/10.1007/s10157-021-02168-8

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  • DOI: https://doi.org/10.1007/s10157-021-02168-8

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