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Gender-specific differences in hemodialysis patients: a multicenter longitudinal study from Serbia

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Abstract

Purpose

The study was undertaken with the aim to determine gender-specific differences in incident hemodialysis (HD) patient and their changes over time.

Methods

The retrospective longitudinal closed cohort study involved 441 incident patients starting HD in 2014 and followed for 1–59 (median 43, IQR 40) months. Demographic, clinical data, treatment characteristics, laboratory findings and outcome were abstracted from the patients’ medical records.

Results

The relative number of males on HD was about twice that of females throughout the five years investigated. At the beginning of the study, no significant differences were found in the main demographic and clinical characteristics except that diabetes was more often the underlying disease in men than in women. Systolic blood pressure decreased over time significantly more in females than in males. Throughout the study spKt/V was significantly higher in females than in males, but it increased in patients of both genders. There were no gender differences for comorbidities, vascular access and the majority of laboratory findings except for higher serum levels of creatinine and CRP in men than in women. Relatively more females were treated with erythropoiesis stimulating agents and phosphate binders than males. Age and malignancy were selected as significant predictors of mortality for both genders, and, in addition, polycystic kidney disease, serum level of albumin and CRP for men, but spKt/V for women.

Conclusion

Some significant gender differences were observed throughout, while others appeared during the study but none of them were due to gender inequalities in the applied treatment.

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References

  1. Hecking M, Bieber BA, Ethier J et al (2014) 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:e1001750. https://doi.org/10.1371/journal.pmed.1001750

    Article  PubMed  PubMed Central  Google Scholar 

  2. Carrero JJ, Hecking M, Chesnaye NC, Jager KJ (2018) Sex and gender disparities in the epidemiology and outcomes of chronic kidney disease. Nat Rev Nephrol 14:151–164. https://doi.org/10.1038/nrneph.2017.181

    Article  PubMed  Google Scholar 

  3. Antlanger M, Noordzij M, van de Luijtgaarden M, On behalf of the ERA-EDTA Registry et al (2019) Sex differences in kidney replacement therapy initiation and maintenance. Clin J Am Soc Nephrol 14:1616–1625. https://doi.org/10.2215/CJN.04400419

    Article  PubMed  PubMed Central  Google Scholar 

  4. Murphy D, McCulloch CE, Lin F, Centers for Disease Control and Prevention Chronic Kidney Disease SurveillanceTeam et al (2016) Trends in prevalence of chronic kidney disease in the United States. Ann Intern Med 165:473–481. https://doi.org/10.7326/m16-0273

    Article  PubMed  PubMed Central  Google Scholar 

  5. Djukanović L, Aksić-Miličević B, Antić M et al (2012) Epidemiology of end-stage renal disease and hemodialysis treatment in Serbia at the turn of the millennium. Hemodial Int 16:517–525. https://doi.org/10.1111/j.1542-4758.2012.00681.x

    Article  PubMed  Google Scholar 

  6. ERA-EDTA Registry: ERA-EDTA Registry Annual Report 2018. Amsterdam: Amsterdam UMC, location AMC, Department of Medical Informatics; 2020 https://www.era-online.org/registry/AnnRep2018.pdf [Accessed 13 August 2021].

  7. Gómez-Marcos MÁ, Recio-Rodríguez JI, Gómez-Sánchez L, LOD-DIABETES Group et al (2015) Gender differences in the progression of target organ damage in patients with increased insulin resistance. Cardiovasc Diabetol 14:132. https://doi.org/10.1186/s12933-015-0293-1

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Yu MK, Katon W, Young BA (2015) Associations between sex and incident chronic kidney disease in a prospective diabetic cohort. Nephrology 20:451–458. https://doi.org/10.1111/nep.12468

    Article  CAS  PubMed  Google Scholar 

  9. Ortona E, Pierdominici M, Maselli A, Veroni C, Aloisi F, Shoenfeld Y (2016) Sex-based differences in autoimmune diseases. Ann Ist Super Sanita 52:205–212. https://doi.org/10.4415/ANN_16_02_12

    Article  CAS  PubMed  Google Scholar 

  10. Neugarten J, Golestaneh L (2019) Influence of sex on the progression of chronic kidney disease. Mayo Clin Proc 94:1339–1356. https://doi.org/10.1016/j.mayocp.2018.12.024

    Article  PubMed  Google Scholar 

  11. Ricardo AC, Yang W, Sha D, Appel LJ, Chen J, KrouselWood M, CRIC Investigators et al (2019) Sex- related disparities in CKD progression. J Am Soc Nephrol 30:137–146. https://doi.org/10.1681/ASN.2018030296

    Article  CAS  PubMed  Google Scholar 

  12. Weigert A, Drozdz M, Silva F et al (2019) Influence of gender and age on haemodialysis practices: a European multicentre analysis. Clin Kidney J 13:217–224. https://doi.org/10.1093/ckj/sfz069

    Article  PubMed  PubMed Central  Google Scholar 

  13. Oliveira TS, Valente AT, Caetano CG, Garagarza CA (2017) Nutritional parameters as mortality predictors in haemodialysis: differences between genders. J Ren Care 43:83–91. https://doi.org/10.1111/jorc.12201

    Article  PubMed  Google Scholar 

  14. Kainz A, Berner C, Ristl R et al (2019) Sex-specific analysis of haemodialysis prevalence, practices and mortality over time: the Austrian dialysis registry from 1965 to 2014. Nephrol Dial Transplant 34:1026–1035. https://doi.org/10.1093/ndt/gfy322

    Article  PubMed  Google Scholar 

  15. Daugirdas JT (1993) Second generation logarithmic estimates of single-pool variable volume Kt/V: an analysis of error. J Am Soc Nephrol 4:1205–1213. https://doi.org/10.1681/ASN.V451205

    Article  CAS  PubMed  Google Scholar 

  16. Iseki K, Nakai S, Shinzato T, Nagura Z, Akiba T, Patient Registration Committee of the Japanese Society for Dialysis Therapy (2005) Increasing gender difference in the incidence of chronic dialysis therapy in Japan. Ther Apher Dial 9:407–411. https://doi.org/10.1111/j.1744-9987.2005.00318.x

    Article  PubMed  Google Scholar 

  17. Johansen KL, Chertow GM, Foley RN et al (2021) US Renal Data System 2020 Annual data report: epidemiology of kidney disease in the United States. Am J Kidney Dis 77(1):Svii-Sviii. https://doi.org/10.1053/j.ajkd.2021.01.002 (S1-S597)

    Article  Google Scholar 

  18. Fernandez-Prado R, Fernandez-Fernandez B, Ortiz A (2018) Women and renal replacement therapy in Europe: lower incidence, equal access to transplantation, longer survival than men. Clin Kidney J 11:1–6. https://doi.org/10.1093/ckj/sfx154

    Article  PubMed  PubMed Central  Google Scholar 

  19. Cobo G, Hecking M, Port FK, Exner I, Lindholm B, Stenvinkel P, Carrero JJ (2016) Sex and gender differences in chronic kidney disease: progression to end-stage renal disease and haemodialysis. Clin Sci 130:1147–1163. https://doi.org/10.1042/CS20160047

    Article  Google Scholar 

  20. McKercher C, Jose MD, Grace B, Clayton PA, Walter M (2017) Gender differences in the dialysis treatment of Indigenous and non-Indigenous Australians. Aust N Z J Public Health 41:15–20. https://doi.org/10.1111/1753-6405.12621

    Article  PubMed  Google Scholar 

  21. Shah S, Leonard AC, Meganathan K, Christianson AL, Thakar CV (2018) Gender and racial disparities in initial hemodialysis access and outcomes in incident end-stage renal disease patients. Am J Nephrol 48:4–14. https://doi.org/10.1159/000490624

    Article  PubMed  Google Scholar 

  22. Park JM, Lee JH, Jang HM, Park Y, Kim YS, Kang SW, Clinical Research Center for End Stage Renal Disease (CRC for ESRD) Investigators et al (2018) Survival in patients on hemodialysis: effect of gender according to body mass index and creatinine. PLoS ONE 13:e0196550. https://doi.org/10.1371/journal.pone.0196550

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. National Kidney Foundation (2015) KDOQI clinical practice guideline for hemodialysis adequacy: 2015 update. Am J Kidney Dis 66:884–930. https://doi.org/10.1053/j.ajkd.2015.07.015

    Article  Google Scholar 

  24. Spalding EM, Chandna SM, Davenport A, Farrington K (2008) Kt/V underestimates the hemodialysis dose in women and small men. Kidney Int 74:348–355. https://doi.org/10.1038/ki.2008.185

    Article  PubMed  Google Scholar 

  25. Daugirdas JT, Depner TA, Greene T, Kuhlmann MK, Levin NW, Chertow GM, Rocco MV (2008) Surface-area-normalized Kt/V: a method of rescaling dialysis dose to body surface area-implications for different-size patients by gender. Semin Dial 21:415–421. https://doi.org/10.1111/j.1525-139X.2008.00482.x

    Article  PubMed  PubMed Central  Google Scholar 

  26. Depner T, Daugirdas J, Greene T, Allon M, Beck G, Chumlea C et al (2004) Dialysis dose and the effect of gender and body size on outcome in the HEMO Study. Kidney Int 65:1386–1394. https://doi.org/10.1111/j.1523-1755.2004.00519.x

    Article  PubMed  Google Scholar 

  27. Ramirez SP, Kapke A, Port FK 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. https://doi.org/10.2215/CJN.00390112

    Article  PubMed  PubMed Central  Google Scholar 

  28. Naveh-Many T, Epstein E, Silver J (1995) Oestrogens and calcium regulatory hormones: potential implications for bone. Curr Opin Nephrol Hypertens 4:319–323. https://doi.org/10.1097/00041552-199507000-00006

    Article  CAS  PubMed  Google Scholar 

  29. Prince RL (1994) Estrogen effects on calciotrophic hormones and calcium homeostasis. Endocr Rev 15:301–309. https://doi.org/10.1210/edrv-15-3-301

    Article  CAS  PubMed  Google Scholar 

  30. Van Abel M, Hoenderop JG, Dardenne O, St Arnaud R, Van Os CH, Van Leeuwen HJ, Bindels RJM (2002) 1,25-dihydroxyvitamin D(3)-independent stimulatory effect of estrogen on the expression of ECaC1 in the kidney. J Am Soc Nephrol 13:2102–2109. https://doi.org/10.1097/01.asn.0000022423.34922.2a

    Article  PubMed  Google Scholar 

  31. Lomonte C, Cazzato F, Casucci F, Chimienti D, Bruno A, Cocola S, Verrelli EA, Basile C (2005) Female hemodialysis patients have an increased risk of nodular hyperplasia of parathyroid glands. J Nephrol 18:92–95

    PubMed  Google Scholar 

  32. Umeukeje EM, Merighi JR, Browne T, Wild M, Alsmaan H, Umanath K et al (2016) Health care providers’ support of patients’ autonomy, phosphate medication adherence, race and gender in end stage renal disease. J Behav Med 39:1104–1114. https://doi.org/10.1007/s10865-016-9745-7

    Article  PubMed  PubMed Central  Google Scholar 

  33. Lopez-Gomez JM, Portoles JM, Aljama P (2008) Factors that condition the response to erythropoietin in patients on hemodialysis and their relation to mortality. Kidney Int Suppl 111:S75-81. https://doi.org/10.1038/ki.2008.523

    Article  CAS  Google Scholar 

  34. Kainz A, Mayer B, Kramar R, Oberbauer R (2010) Association of ESA hypo-responsiveness and haemoglobin variability with mortality in haemodialysis patients. Nephrol Dial Transplant 25:3701–3706. https://doi.org/10.1093/ndt/gfq287

    Article  CAS  PubMed  Google Scholar 

  35. Fernandez-Prado R, Castillo-Rodriguez E, Velez-Arribas FJ, Gracia-Iguacel C, Ortiz A (2016) Women and renal replacement therapy in Europe: lower incidence, equal access to transplantation, longer survival than men. Am J Med 129:1259–1263. https://doi.org/10.1093/ckj/sfx154

    Article  CAS  PubMed  Google Scholar 

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Academy of Medical Sciences of Serbian Medical Society, Belgrade, Serbia

    Ljubica Djukanović, Višnja Ležaić & Nada Dimković

  2. School of Medicine, University of Belgrade, Dr Subotica 8, 11 000, Belgrade, Serbia

    Ljubica Djukanović, Višnja Ležaić, Nada Dimković & Jelena Marinković

  3. Nephrology Ward, General Hospital, Kraljevo, Serbia

    Biserka Aksić Milićević

  4. Nephrology Ward, General Hospital, Čačak, Serbia

    Svetlana Arsenijević & Biljana Ceković

  5. Special Hospital of Internal Medicine, Lazarevac, Serbia

    Aleksandra Arsenović

  6. Clinic of Nephrology and Clinical Immunology, Univeristy Clinical Center of Vojvodina, Novi Sad, Serbia

    Dejan Ćelić & Violeta Knežević

  7. Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia

    Dejan Ćelić & Violeta Knežević

  8. Nephrology Ward, General Hospital, Smederevska Palanka, Serbia

    Verica Djordjević

  9. Nephrology Ward, General Hospital, Kikinda, Serbia

    Miloš Djurin

  10. Nephrology Ward, General Hospital, Loznica, Serbia

    Nenad Filipović

  11. Department of Nephrology, University Clinical Center of Serbia, Belgrade, Serbia

    Selena Gajić

  12. Nephrology Ward, General Hospital, Pirot, Serbia

    Branimir Haviža-Lilić

  13. Nephrology Ward, General Hospital, Sombor, Serbia

    Miloš Jandrić

  14. Nephrology Ward, Health Center, Žagubica, Serbia

    Nasta Jovanović

  15. Nephrology Ward, Health Center, Priboj, Serbia

    Svetlana Krsmanović

  16. Department of Nephrology, Zvezdara Clinical Hospital Center, Belgrade, Serbia

    Dragana Marković

  17. Department of Nephrology, Military Medical Academy, Belgrade, Serbia

    Djoko Maksić

  18. FMC Special Hemodialysis Hospital, Belgrade, Serbia

    Jelena Maslovarić

  19. Nephrology Ward, General Hospital, Užice, Serbia

    Snežana Milanović

  20. Department of Nephrology, University Clinical Center, Niš, Serbia

    Branka Mitić

  21. Nephrology Department, Zemun Clinical Hospital Center, Zemun-Belgrade, Serbia

    Ana Ostojić

  22. FMC Special Hemodialysis Hospital, Novi Sad, Serbia

    Dobrila Petković

  23. Nephrology Ward, Health Center, Bačka Palanka, Serbia

    Dragana Pilipović & Jadranka Uzelac

  24. Nephrology Ward, General Hospital, Leskovac, Serbia

    Miodrag Sokolović

  25. Nephrology Ward, General Hospital, Šabac, Serbia

    Dragana Stanković

  26. Nephrology Ward, General Hospital, Mladenovac, Serbia

    Marina Stojanović

  27. Nephrology Ward, General Hospital, Subotica, Serbia

    Tatjana Stojšić Vuksanović

  28. Nephrology Ward, General Hospital, Zaječar, Serbia

    Biserka Tirmenštajn

  29. Nephrology Ward, General Hospital, Valjevo, Serbia

    Nataša Vesić

  30. Nephrology Ward, General Hospital, Pančevo, Serbia

    Goran Vojinović

  31. Medicon Special Hemodialysis Hospital, Belgrade, Serbia

    Vanja Vukša

Authors
  1. Ljubica Djukanović
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  2. Višnja Ležaić
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  3. Nada Dimković
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  4. Jelena Marinković
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  5. Biserka Aksić Milićević
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  6. Svetlana Arsenijević
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  7. Aleksandra Arsenović
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  8. Biljana Ceković
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  9. Dejan Ćelić
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  12. Nenad Filipović
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  13. Selena Gajić
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  14. Branimir Haviža-Lilić
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  15. Miloš Jandrić
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  16. Nasta Jovanović
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  17. Violeta Knežević
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  18. Svetlana Krsmanović
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  19. Dragana Marković
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  20. Djoko Maksić
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  21. Jelena Maslovarić
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  22. Snežana Milanović
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  23. Branka Mitić
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  25. Dobrila Petković
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  26. Dragana Pilipović
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  27. Miodrag Sokolović
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  28. Dragana Stanković
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  29. Marina Stojanović
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  30. Tatjana Stojšić Vuksanović
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  31. Biserka Tirmenštajn
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  32. Jadranka Uzelac
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  33. Nataša Vesić
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  34. Goran Vojinović
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  35. Vanja Vukša
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Corresponding author

Correspondence to Ljubica Djukanović.

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The authors declare that they have no conflicts of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Djukanović, L., Ležaić, V., Dimković, N. et al. Gender-specific differences in hemodialysis patients: a multicenter longitudinal study from Serbia. Int Urol Nephrol 54, 3233–3242 (2022). https://doi.org/10.1007/s11255-022-03247-9

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