Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
Fukuoka Renal Clinic, Fukuoka, Japan.
Sci Rep. 2022 Jan 10;12(1):345. doi: 10.1038/s41598-021-03551-x.
Women have a longer life expectancy than men in the general population. However, it has remained unclear whether this advantage is maintained in patients undergoing maintenance hemodialysis. The aim of this study was to compare the risk of mortality, especially infection-related mortality, between male and female hemodialysis patients. A total of 3065 Japanese hemodialysis patients aged ≥ 18 years old were followed up for 10 years. The primary outcomes were all-cause and infection-related mortality. The associations between sex and these outcomes were examined using Cox proportional hazards models. During the median follow-up of 8.8 years, 1498 patients died of any cause, 387 of whom died of infection. Compared with men, the multivariable-adjusted hazard ratios (95% confidence interval) for all-cause and infection-related mortality in women were 0.51 (0.45-0.58, P < 0.05) and 0.36 (0.27-0.47, P < 0.05), respectively. These findings remained significant even when propensity score-matching or inverse probability of treatment weighting adjustment methods were employed. Furthermore, even when the non-infection-related mortality was considered a competing risk, the infection-related mortality rate in women was still significantly lower than that in men. Regarding all-cause and infection-related deaths, women have a survival advantage compared with men among Japanese patients undergoing maintenance hemodialysis.
女性在普通人群中的预期寿命比男性长。然而，在接受维持性血液透析的患者中，这种优势是否仍然存在尚不清楚。本研究旨在比较男性和女性血液透析患者的死亡率，特别是感染相关死亡率。共纳入了 3065 名年龄≥18 岁的日本血液透析患者，随访 10 年。主要结局为全因死亡率和感染相关死亡率。使用 Cox 比例风险模型检查性别与这些结局之间的关系。在中位数为 8.8 年的随访期间，1498 名患者死于任何原因，其中 387 名死于感染。与男性相比，女性的全因死亡率和感染相关死亡率的多变量调整后的危险比（95%置信区间）分别为 0.51（0.45-0.58，P<0.05）和 0.36（0.27-0.47，P<0.05）。即使采用倾向评分匹配或治疗反概率加权调整方法，这些发现仍然具有统计学意义。此外，即使将非感染相关死亡率视为竞争风险，女性的感染相关死亡率仍明显低于男性。对于全因和感染相关死亡，与男性相比，女性在接受维持性血液透析的日本患者中具有生存优势。
