Women on Dialysis Face Lower Mortality, Higher Heart Failure and Stroke

Women vs men receiving dialysis have a lower adjusted risk for cardiovascular mortality and all-cause mortality although a higher risk for heart failure and stroke, according to study findings published in the Journal of the American Heart Association.

Investigators sought to characterize sex differences in cardiovascular death, all-cause death, and cardiovascular events among patients on dialysis. Hospitalization with a primary diagnosis of acute coronary syndrome, heart failure, stroke, or a composite of 2 or more of those outcomes, or cardiovascular death, or all-cause death were the primary outcomes.

The investigators conducted an observational study using data from the United States Renal Data System with linked Medicare claims for patients initiating dialysis from January 2005 through December 2014. Patients (N=508,822) were at least 18 years of age with incident end-stage kidney disease. A majority of patients had history of cardiovascular disease (91.4%). The most common causes of kidney failure were diabetes (45.0%) and hypertension (31.3%).

Overall, patients (mean age, 70 [SD, 12] years; 44.7% women; 61.6% non-Hispanic White, 23.5% non-Hispanic Black, 10.6% Hispanic) experienced cardiovascular events at a rate of 232/thousand person-years (95% CI, 231-233), although women vs men had a higher rate (248/thousand person-years; 95% CI, 247-250; vs 219/thousand person-years; 95% CI, 217-220; respectively). Women vs men were more likely to be Black, less likely to be White, more likely to have diabetes and poor functional status, and less likely to be smokers.

Women vs men had no difference in risk for acute coronary syndrome (hazard ratio [HR], 1.01; 95% CI, 0.99-1.03), 31% higher risk for stroke (HR, 1.31; 95% CI, 1.28-1.34), and 16% higher risk for heart failure (HR, 1.16; 95% CI, 1.15-1.18). Women vs men faced a lower risk of cardiovascular death (HR, 0.89; 95% CI, 0.88-0.90) and lower risk of all-cause death (HR, 0.96; 95% CI, 0.95-0.97).

Study limitations include the observational design precluding the determination of causality, unaccounted-for endogenous hormone levels, and inability to evaluate cardiovascular health-seeking behavior in women vs men.

“Among patients undergoing dialysis, women have a higher risk of cardiovascular events of heart failure and stroke than men. Women have a lower adjusted risk of cardiovascular mortality and all-cause mortality,” the investigators concluded. “These differences were not explained by age, race or ethnicity, or history of prior cardiovascular disease.”

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on The Cardiology Advisor