Sex Disparity in Cause-Specific and All-Cause Mortality Among Incident Dialysis Patients

Wai H. Lim, Jenny H.C. Chen, Kimberley Minas, David W. Johnson, Maleeka Ladhani, Esther Ooi, Neil Boudville, Carmel Hawley, Andrea K. Viecelli, Matthew Roberts, Kate Wyburn, Rachael Walker, Monique Borlace, Helen Pilmore, Christopher E. Davies, Charmaine E. Lok, Armando Teixeira-Pinto, Germaine Wong

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Rationale & Objective: Early mortality rates of female patients receiving dialysis have been, at times, observed to be higher than rates among male patients. The differences in cause-specific mortality between male and female incident dialysis patients with kidney failure are not well understood and were the focus of this study. Study Design: Retrospective cohort study. Setting & Participants: Incident patients who had initiated dialysis in Australia and New Zealand in 1998-2018. Exposure: Sex. Outcomes: Cause-specific and all-cause mortality while receiving dialysis, censored for kidney transplant. Analytical Approach: Adjusted cause-specific proportional hazards models, focusing on the first 5 years following initiation of dialysis. Results: Among 53,414 patients (20,876 [39%] female) followed for a median period of 2.8 (IQR, 1.3-5.2) years, 27,137 (51%) died, with the predominant cause of death attributed to cardiovascular disease (18%), followed by dialysis withdrawal (16%). Compared with male patients, female patients were more likely to die in the first 5 years after dialysis initiation (adjusted hazard ratio [AHR], 1.08 [95% CI, 1.05-1.11]). Even though female patients experienced a lower risk of cardiovascular disease–related mortality (AHR, 0.93 [95% CI, 0.89-0.98]) than male patients, they experienced a greater risk of infection-related (AHR, 1.20 [95% CI, 1.10-1.32]) and dialysis withdrawal–related (AHR, 1.19 [95% CI, 1.13-1.26]) mortality. Limitations: Possibility of residual and unmeasured confounders. Conclusions: Compared with male patients, female patients had a higher risk of all-cause mortality in the first 5 years after dialysis initiation, a difference driven by higher rates of mortality from infections and dialysis withdrawals. These findings may inform the study of sex differences in mortality in other geographic settings.
Original languageEnglish
Pages (from-to)156-167.e1
JournalAmerican Journal of Kidney Diseases
Issue number2
Publication statusPublished - Feb 2023


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