Abstract 9607: Sex Differences in Cardiovascular Outcomes in Dialysis Patients

Abstract

Background: Cardiovascular disease is the leading cause of mortality in patients with kidney failure, and their risk of cardiovascular events is 10 to 20 times higher as compared to the general population. Little is known about sex differences in cardiovascular outcomes in dialysis patients which precludes sex-specific therapies. Methods: We evaluated 508,822 patients who initiated dialysis between 1/1/2005 and 12/31/2014 using the United States Renal Data System with linked Medicare claims. We determined rates of hospitalizations for cardiovascular events, defined by acute coronary syndrome, heart failure, and stroke. We examined the association of sex with the outcome of cardiovascular events, cardiovascular death, and all-cause death, using adjusted time-to-event models. Results: The mean age of patients in the study cohort was 70±12 years, and 44.7% were women. The cardiovascular event rate was 232 PTPY (95% CI, 231-233), with a higher rate in women than in men (248 PTPY; 95% CI, 247-250 vs. 219 PTPY; 95% CI, 217-220). Women had a 13% higher risk of cardiovascular events than did men (HR, 1.13; 95% CI, 1.11-1.14). Women had a 15% higher risk of heart failure (HR, 1.15; 95% CI, 1.13-1.16), a 29% higher risk of stroke (HR, 1.29; 95% CI, 1.26-1.32), and no difference in risk of acute coronary syndrome (HR, 0.99; 95% CI, 0.97-1.01). Women had a lower risk of cardiovascular death (HR, 0.84; 95% CI, 0.83-0.85), and a lower risk of all-cause death, as compared to men (OR, 0.92; 95% CI, 0.91-0.93). Conclusion: 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. Further studies are needed to better understand the factors associated with sex differences in cardiovascular outcomes in patients with kidney failure.