Do higher measures of hemodialysis adequacy and quality improve cardiovascular outcomes and mortality differently by sex in adults living with kidney failure on maintenance hemodialysis?
Female patients on maintenance hemodialysis may derive a greater mortality benefit from higher hemodialysis adequacy and quality measures compared to male patients, highlighting the need for sex-specific considerations in dialysis care.
Rationale only 10 studies reported the interaction by sex. Multiple measures of adequacy with varying definitions of 'higher' and 'lower' values were reported, with Kt/V being the most common. Three studies reported a greater decrease in all-cause mortality in female than in male individuals with higher single-pool Kt/V; 1 study reported no difference by sex. One study reported a greater decrease in all-cause mortality in female than in male individuals with higher urea reduction ratio; 1 study reported no difference by sex. One study reported a greater decrease in all-cause mortality in female than in male individuals with greater weekly hemodialysis treatment times; 1 study reported no difference by sex. Two studies reported greater all-cause mortality with higher ultrafiltration rate in female than in male individuals. Limitations: Inconsistent reporting of hemodialysis adequacy and quality measures. Inconsistent inclusion of factors known to impact important clinical outcomes. Conclusions: Although the results should be interpreted with caution due to significant study heterogeneity, female individuals may derive greater benefit from higher values of hemodialysis adequacy and quality measures than male individuals.
Riehl-Tonn et al. (Thu,) studied this question.