Gender-Related Differences and Mortality Predictors among Egyptian Hemodialysis Patients: A Multi-Center Prospective Observational Study

Main Article Content

Abir Farouk Megahed
Mona Mohammed Tawfik Abdelhady
Ghada El Kannishy
Nagy Sayed- Ahmed

Abstract

Background: End-stage renal disease (ESRD) is an important cause of global morbidity and mortality affecting both sexes. Both genders may present with different symptoms and signs, respond differently to therapy and may exhibit different degrees of tolerance towards their disease. In Egypt, hemodialysis (HD) constitutes the most common modality of renal replacement therapy and the number of hemodialysis patients is increasing. The objective of the present study was to investigate gender-related differences in clinical and biochemical characteristics in HD patients. Mortality events in both genders were also recorded and predictors of mortality in the included HD population were explored.

Methods: This multicenter study adopted essentially a cross-sectional design and included 2158 patients (1241 males and 917 females) undergoing HD in 25 hemodialysis units in six governorates in Egypt. The study started at June 2016 till May 2017. Data were extracted from the patients' records. One year mortality events in the included HD patients were prospectively observed and recorded.

Results: Males on HD had a significantly lower body mass index (BMI) values and were less efficiently dialyzed. Their blood pressure measurements were significantly higher. In addition, males had significantly higher serum albumin with a significantly lower serum potassium level. The overall mortality rate was 6.9% (149 deaths) during the one year follow up period with a significant male predominance (7.9% in males vs. 5.6% in females p=0.03). The mortality rate was highest within the first 14 months after starting hemodialysis therapy. Mortality was statistically significantly higher in patients with diabetes, ischemic heart disease (IHD), anemia with low hemoglobin, and low serum albumin. The mortality risk is nearly duplicated in HD patients with IHD, while low serum albumin was associated with about 3 times an increase in mortality risk in the studied HD patients. 

Conclusion: Gender differences in clinical and laboratory characteristics and mortality do exist in Egyptian HD patients and should be considered when management guidelines are developed to suit the gender-related variations.

Keywords:
Gender differences, morbidity, mortality, Egyptian hemodialysis.

Article Details

How to Cite
Megahed, A. F., Abdelhady, M. M. T., Kannishy, G. E., & Ahmed, N. S.-. (2020). Gender-Related Differences and Mortality Predictors among Egyptian Hemodialysis Patients: A Multi-Center Prospective Observational Study. Asian Journal of Medicine and Health, 18(10), 118-130. https://doi.org/10.9734/ajmah/2020/v18i1030259
Section
Original Research Article

References

Singh AK, Farag YM, Mittal BV, Subramanian KK, Reddy SRK, Acharya VN, et al. Epidemiology and risk factors of chronic kidney disease in India–results from the SEEK (Screening and Early Evaluation of Kidney Disease) study. BMC nephrology. 2013;14(1):114.

Megahed AFand El-Azzawi. H MOH hemodialysis Registry: Comparing Services 2016 VS 2017.1st Acute Renal Dialysis Symposium, Baxter company, 20th & 21th July, 2017, Alexandria, Egypt.

Held PJ, Pauly MV, Diamond L. Survival analysis of patients undergoing dialysis. Jama. 1987;257(5):645-50.

Hutchinson TA, Thomas DC, Macgibbon B. Predicting survival in adults with end-stage renal disease: an age equivalence index. Annals of Internal Medicine. 1982;96(4): 417-23.

McClellan WM, Flanders WD, Gutman RA. Variable mortality rates among dialysis treatment centers. Ann Intern Med. 1992; 117(4):332-6.

Floege J, Gillespie IA, Kronenberg F, Anker SD, Gioni I, Richards S, et al. Development and validation of a predictive mortality risk score from a European hemodialysis cohort. Kidney International. 2015;87(5):996-1008.

Cobo G, Hecking M, Port FK, Exner I, Lindholm B, Stenvinkel P, et al. Sex and gender differences in chronic kidney disease: progression to end-stage renal disease and haemodialysis. Clinical Science. 2016;130(14):1147-63.

Megahed AF, El-Kannishy G, Sayed-Ahmed N. Status of fasting in Ramadan of chronic hemodialysis patients all over Egypt: A multicenter observational study. Saudi J Kidney Dis Transpl 2019;30:339-49. Available:https://manshurat.org/node/14544

Coresh J, Astor BC, Greene T, Eknoyan G, Levey AS. Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey. American journal of kidney diseases. 2003;41(1):1-12.

Li Z-Y, Xu G-B, Xia T-A, Wang H-Y. Prevalence of chronic kidney disease in a middle and old-aged population of Beijing. Clinica Chimica Acta. 2006;15-209(1-2): 366.

Ninomiya T, Kiyohara Y, Kubo M, Tanizaki Y, Doi Y, Okubo K, et al. Chronic kidney disease and cardiovascular disease in a general Japanese population: The Hisayama Study. Kidney International. 2005;68(1):228-36.

Hemmelgarn B, Zhang J, Manns B, Tonelli M, Larsen E, Ghali W, et al. Progression of kidney dysfunction in the community-dwelling elderly. Kidney International. 2006;69(12):2155-61.

Zhang Q-L, Rothenbacher D. Prevalence of chronic kidney disease in population-based studies: Systematic review. BMC Public Health. 2008;8(1):117.

System URD. USRDS 2013 annual data report: atlas of chronic kidney disease and end-stage renal disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive; 2013.

Bikbov B, Perico N, Remuzzi G. Disparities in chronic kidney disease prevalence among males and females in 195 countries: Analysis of the Global Burden of Disease 2016 Study. Nephron. 2018;139: 313-8.

Hecking M, Bieber BA, Ethier J, Kautzky-Willer A, Sunder-Plassmann G, Säemann MD, et al. Sex-specific differences in hemodialysis prevalence and practices and the male-to-female mortality rate: The Dialysis Outcomes and Practice Patterns Study (DOPPS). PLoS Medicine. 2014; 11(10):e.100175.

Artan AS, Kircelli F, Ok E, Yilmaz M, Asci G, Dogan C, et al. Dialyzing women and men: does it matter? An observational study. Clinical Kidney Journal. 2016;9(3): 486-93.

Nguyen B, Fukuuchi F. Survival rates and causes of death in Vietnamese chronic hemodialysis patients. Renal Replacement Therapy. 2017;3(1):22.

El-Zorkany KM. Maintenance hemodialysis in Menoufia governorate, Egypt: Is there any progress? Journal of the Egyptian Society of Nephrology and Transplantation. 2017;17(2):58.

Park J-M, Lee J-H, Jang HM, Park Y, Kim YS, Kang S-W, et al. Survival in patients on hemodialysis: Effect of gender according to body mass index and creatinine. PloS One. 2018;13(5): e0196550.

Neugarten J, Acharya A, Silbiger SR. Effect of gender on the progression of nondiabetic renal disease: A meta-analysis. Journal of the American Society of Nephrology. 2000;11(2):319-29.

Fanelli C, Dellê H, Cavaglieri RC, Dominguez WV, Noronha IL. Gender differences in the progression of experimental chronic kidney disease induced by chronic nitric oxide inhibition. BioMed research international; 2017.

Okaka EI, Okwuonu CG. Blood pressure variation and its correlates among patients undergoing hemodialysis for renal failure in Benin City, Nigeria. Annals of African medicine. 2017;16(2):65.

Basu R, Dalla Man C, Campioni M, Basu A, Klee G, Toffolo G, et al. Effects of age and sex on postprandial glucose metabolism: differences in glucose turnover, insulin secretion, insulin action, and hepatic insulin extraction. Diabetes. 2006;55(7):2001-14.

Depner T, Daugirdas J, Greene T, Allon M, Beck G, Chumlea C, et al. Dialysis dose and the effect of gender and body size on outcome in the HEMO Study. Kidney International. 2004;65(4):1386-94.

Weigert A, Drozdz M, Silva F, Frazão J, Alsuwaida A, Krishnan M, et al. Influence of gender and age on haemodialysis practices: a European multicentre analysis. Clinical Kidney Journal. 2020;13(2):217–224.

Takaki J, Yano E. Possible gender differences in the relationships of self-efficacy and the internal locus of control with compliance in hemodialysis patients. Behavioral Medicine. 2006;32(1):5-11.

El Makarem MAA, Hamid MA, Aleem AA, Ali A, Shatat M, Sayed D, et al. Prevalence of occult hepatitis B virus infection in hemodialysis patients from egypt with or without hepatitis C virus infection. Hepatitis Monthly. 2012;12(4):253.

Blumberg BS. Hepatitis B and the Prevention of Primary Cancer of the Liver: Selected Publications of Baruch S. Blumberg: World Scientific; 2000.

Blumberg BS. Sex differences in response to hepatitis B virus. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology. 1979; 22(11):1261-6.

Murphy WG. The sex difference in haemoglobin levels in adults—mechanisms, causes, and consequences. Blood Reviews. 2014;28(2):41-7.

Masakane I, Nakai S, Ogata S, Kimata N, Hanafusa N, Hamano T, et al. An overview of regular dialysis treatment in Japan (as of 31 December 2013). Therapeutic Apheresis and Dialysis. 2015;19(6):540-74.

Nakai S, Iseki K, Itami N, Ogata S, Kazama JJ, Kimata N, et al. An overview of regular dialysis treatment in Japan (as of 31 December 2010). Therapeutic Apheresis and Dialysis. 2012;16(6):483-521.

Daugirdas JT, Depner TA, Inrig J, Mehrotra R, Rocco MV, Suri RS, et al. KDOQI clinical practice guideline for hemodialysis adequacy: 2015 update. American Journal of Kidney Diseases. 2015;66(5):884-930.

Kautzky-Willer A, Dorner T, Jensby A, Rieder A. 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. 2012;12: 392.

Lancet T. Taking sex into account in medicine. Elsevier; 2011.

Megahed A, Tawfik M, El-Kannishy G, El-Said G, Hassan R, Mohamed N, et al. SP610 Mortality risk in patients on maintenance hemodialysis in relation to gender: a multicenter observational study in Egypt. Nephrology Dialysis Transplantation. 2018;33(suppl_1):i552-i.

Carrero JJ, de Jager DJ, Verduijn M, Ravani P, De Meester J, Heaf JG, et al. Cardiovascular and noncardiovascular mortality among men and women starting dialysis. Clinical Journal of the American Society of Nephrology. 2011;6(7):1722-30.

Choi H, Kim M, Kim H, Lee JP, Lee J, Park JT, et al. Excess mortality among patients on dialysis: Comparison with the general population in Korea. Kidney Research and Clinical Practice. 2014;33(2):89-94.

Inaguma D, Koide S, Takahashi K, Hayashi H, Hasegawa M, Yuzawa Y. Relationship between serum calcium level at dialysis initiation and subsequent prognosis. Renal Replacement Therapy. 2017;3(1):2.

Locatelli F, Pozzoni P, Tentori F, Del Vecchio L. Epidemiology of cardiovascular risk in patients with chronic kidney disease. Nephrology Dialysis Transplantation. 2003; 18(suppl_7):vii2-vii9.

de Jager DJ, Grootendorst DC, Jager KJ, van Dijk PC, Tomas LM, Ansell D, et al. Cardiovascular and noncardiovascular mortality among patients starting dialysis. Jama. 2009;302(16):1782-9.

Lowrie EG, Lew NL. Death risk in hemodialysis patients: the predictive value of commonly measured variables and an evaluation of death rate differences between facilities. American Journal of Kidney Diseases. 1990;15(5):458-82.

Menon V, Greene T, Wang X, Pereira AA, Marcovina SM, Beck GJ, et al. C-reactive protein and albumin as predictors of all-cause and cardiovascular mortality in chronic kidney disease. Kidney International. 2005;68(2):766-72.

Robinson BM, Zhang J, Morgenstern H, Bradbury BD, Ng LJ, McCullough KP, et al. Worldwide, mortality risk is high soon after initiation of hemodialysis. Kidney International. 2014;85(1):158-65.

Lukowsky LR, Kheifets L, Arah OA, Nissenson AR, Kalantar-Zadeh K. Patterns and predictors of early mortality in incident hemodialysis patients: New insights. American Journal of Nephrology. 2012; 35(6):548-58.

Bradbury BD, Fissell RB, Albert JM, Anthony MS, Critchlow CW, Pisoni RL, et al. Predictors of early mortality among incident US hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Clinical Journal of the American Society of Nephrology. 2007; 2(1):89-99.

Young EW, Albert JM, Satayathum S, Goodkin DA, Pisoni RL, Akiba T, et al. Predictors and consequences of altered mineral metabolism: the Dialysis Outcomes and Practice Patterns Study. Kidney International. 2005;67(3): 1179-87.

Kalantar-Zadeh K, Kuwae N, Regidor D, Kovesdy C, Kilpatrick R, Shinaberger C, et al. Survival predictability of time- varying indicators of bone disease in maintenance hemodialysis patients. Kidney International. 2006;70(4):771- 80.

Tentori F, Blayney MJ, Albert JM, Gillespie BW, Kerr PG, Bommer J, et al. Mortality risk for dialysis patients with different levels of serum calcium, phosphorus, and PTH: the Dialysis Outcomes and Practice Patterns Study (DOPPS). American Journal of Kidney Diseases. 2008; 52(3):519-30.

Rivara MB, Ravel V, Kalantar-Zadeh K, Streja E, Lau WL, Nissenson AR, et al. Uncorrected and albumin-corrected calcium, phosphorus, and mortality in patients undergoing maintenance dialysis. Journal of the American Society of Nephrology. 2015;26(7):1671-81.

Obi Y, Mehrotra R, Rivara MB, Streja E, Rhee CM, Lau WL, et al. Hidden hypercalcemia and mortality risk in incident hemodialysis patients. The Journal of Clinical Endocrinology & Metabolism. 2016;101(6):2440-9.

Tomaszewski M, Topyła W, Kijewski BG, Miotła P, Waciński P. Does gender influence the outcome of ischemic heart disease?. Menaupause Review. 2019; 18(1):51–56. DOI:10.5114/pm.2019.84158

Eun Ko Y, Yun T, Lee H A, Kim S-J, Kang D-H, Choi K B, et al. Gender-specific discrepancy in subjective global assessment for mortality in hemodialysis patients. Scientific Reports. 2018;8. Article number: 17846.