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

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.