Abstract: FR-PO433
Sex and Age Differences in Hemodialysis Mortality among US Medicare Beneficiaries
Session Information
- Hemodialysis Epidemiology and Outcomes
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Le, Dustin, Johns Hopkins Medicine, Baltimore, Maryland, United States
- Kirby, Grant Thomas, Johns Hopkins Medicine, Baltimore, Maryland, United States
- Grams, Morgan, New York University Grossman School of Medicine, New York, New York, United States
- Srialluri, Nityasree, Johns Hopkins Medicine, Baltimore, Maryland, United States
Background
Recent literature has challenged the observation that women (vs men) have a modest survival advantage on hemodialysis. We aimed to investigate if age of dialysis initiation contributes to sex differences in mortality outcomes among US Medicare beneficiaries.
Methods
Using the US Renal Data System (USRDS) and Medicare A, B and D claims from 2011-2020 we assessed all-cause and cause-specific mortality (cardiovascular [CVD], infection, and withdrawal), comparing females to males who survived 90 days on in-center hemodialysis. Participants were stratified by age (18 – 50, 51- 60, 61 – 70, and 81 – 90) and analyzed using competing risk models to account for the competing risk of kidney transplantation. We estimated competing risk regression hazard ratios (HRs) in the overall population and then within each age stratum, adjusting for baseline demographics, comorbidities, and medication use.
Results
Among 85,453 women and 93,205 men who initiated and survived 90 days of in-center hemodialysis, women had a survival advantage (HR: 0.96, 95% CI: 0.95 – 0.98) driven by lower CVD mortality (HR: 0.88, 95% CI: 0.86 – 0.91). Women had similar infection-related mortality (HR: 1.04, 95% CI: 0.99 – 1.10) and higher withdrawal-attributed mortality (HR: 1.08, 95% CI: 1.04 – 1.12). Women 18 – 50 did not have a survival advantage for all-cause (HR 1.06, 95% CI: 1.00 – 1.13, p-value: 0.06) or CVD mortality (HR 1.02, 95% CI: 0.93 – 1.13), while women aged 51-60 had higher infection-related mortality (HR: 1.18, 95% CI: 1.01 – 1.39), Figure 1. Withdrawal mortality by age strata was consistent with the overall population estimate.
Conclusion
Among US Medicare beneficiaries, the association between sex and mortality varied based on the age at time of dialysis initiation.
* P-value < 0.05
Funding
- Other NIH Support