Background. Although females have a survival advantage in the general population, women undergoing dialysis have similar mortality to men. Because the reasons for this difference are unknown, we... Show moreBackground. Although females have a survival advantage in the general population, women undergoing dialysis have similar mortality to men. Because the reasons for this difference are unknown, we hypothesized that sex differences in cardiovascular disease (CVD) risk profile exist at dialysis initiation and that the association of such risk factors with mortality differs between sexes. Methods. This study was a prospective observational cohort study (NECOSAD) of incident dialysis patients with 5 years of follow-up where we calculated male: female odds ratios (OR) and relative risks of mortality (hazard ratio, HR) for the presence of CVD risk factors at the start of dialysis. We also examined the presence of interaction between sex and CVD risk factors in their association with mortality. Results. In 1577 patients (61% men, 60 +/- 15 years), men presented more CVD co-morbidity [OR: 1.88 (95% CI: 1.51, 2.35)] but less diabetes mellitus (OR: 0.70 [0.55, 0.89]) than women. Both sexes presented equal survival [HR 0.98 (0.83, 1.16)]. Women with diabetes had a higher mortality risk [HR 2.93 (2.27, 3.79)] than their male counterparts [HR 1.99 (1.52, 2.59)], showing an interaction effect between sex and diabetes [relative excess risk due to interaction 1.18 (0.37, 2.00)]. Conclusion. Despite a lower prevalence of CVD, women starting dialysis had the same mortality risk as men. The mortality risk was strikingly higher in diabetic women than diabetic men. This excess mortality may help explain why dialysis cancels out the female survival advantage. Our study identifies a high-risk group of patients that may warrant further investigation and intensified therapeutic care. Show less
The main objective of this thesis was to study the association between nutritional status and survival in end-stage renal disease patients who are maintained on a chronic dialysis treatment. Where... Show moreThe main objective of this thesis was to study the association between nutritional status and survival in end-stage renal disease patients who are maintained on a chronic dialysis treatment. Where as obesity is an established risk factor for morbidity and mortality in the general population, many survival studies in hemodialysis patients have indicated reverse associations of obesity with mortality. We showed, however, that the association between BMI and mortality in the hemodialysis population was similar, and not reversed compared with the general population of equal baseline age and duration of follow-up. Independent from BMI, weight loss and muscle mass depletion were both associated with an increased mortality risk in hemodialysis patients. Furthermore, we observed an interaction effect between protein-energy wasting, inflammation and cardiovascular disease, resulting in excess mortality in chronic dialysis patients. Finally, compared with a normal nutritional status, the short-term impact of protein-energy wasting on mortality appeared more important than the long-term effect. The results of this thesis emphasize the importance of maintaining a good nutritional status in chronic dialysis patients. The nutritional status of dialysis patients should be assessed regularly, at least every 6 months. In clinical practice, the 7-point Subjective global assessment can be used for this. Show less
