Gender Disparities in Vascular Access and One-Year Mortality among Incident Hemodialysis Patients: An Epidemiological Study in Lazio Region, Italy
Abstract
:1. Introduction
2. Materials and Methods
2.1. Source of the Data
2.2. Study Population
2.3. Outcome and Follow-Up
2.4. Exposure
2.5. Co-Variates
2.5.1. Socio-Demographic and Clinical Variables
2.5.2. Care-Related Variables
2.5.3. Laboratory Findings
2.6. Statistical Analysis
2.6.1. Association between Gender and Type of Vascular Access
2.6.2. Association between Gender and 1-Year Mortality
3. Results
3.1. Association between Gender and Type of Vascular Access
3.2. Association between Gender and 1-Year Mortality
4. Discussion
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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GENDER | |||||||
---|---|---|---|---|---|---|---|
MALE | FEMALE | Total | p-Value * | ||||
n | % | n | % | n | |||
Total | 5868 | 100.0 | 3200 | 100.0 | 9068 | ||
Age class | (years) | 0.003 | |||||
18–49 | 714 | 12.2 | 380 | 11.9 | 1094 | ||
50–64 | 1260 | 21.5 | 674 | 21.1 | 1934 | ||
65–74 | 1595 | 27.2 | 793 | 24.8 | 2388 | ||
75–84 | 1816 | 31.0 | 1021 | 31.9 | 2837 | ||
85+ | 483 | 8.2 | 332 | 10.4 | 815 | ||
Age (years) mean ± std | 5868 | 68.1 ± 14.1 | 3200 | 68.5 ± 14.7 | 9068 | 0.124 | |
Education qualification | <0.001 | ||||||
No qualifications/Elementary School/Middle School | 3627 | 61.8 | 2353 | 73.5 | 5980 | ||
High School/Degree and more | 2241 | 38.2 | >847 | >26.5 | >3088 | ||
Body Mass Index | <0.001 | ||||||
Underweight (BMI < 18.0) | 208 | 3.5 | 283 | 8.8 | 491 | ||
Normal weight (18.0 ≤ BMI < 25.0) | 3071 | 52.3 | 1561 | 48.8 | 4632 | ||
Overweight (25.0 ≤ BMI < 30.0) | 1884 | 32.1 | 797 | 24.9 | 2681 | ||
Obese (BMI ≥ 30.0) | >705 | >12.0 | >559 | >17.5 | >1264 | ||
Self-sufficient | <0.001 | ||||||
Complete | 2955 | 50.4 | 1289 | 40.3 | 4244 | ||
Little self-sufficient | 1692 | 28.8 | 943 | 29.5 | 2635 | ||
Not self-sufficient | 1221 | 20.8 | 968 | 30.3 | 2189 | ||
Comorbidities | |||||||
Heart disease | 2313 | 39.4 | 980 | 30.6 | 3293 | <0.001 | |
Peripheral vascular diseases | 988 | 16.8 | 335 | 10.5 | 1323 | <0.001 | |
Cerebrovascular disease | 866 | 14.8 | 385 | 12.0 | 1251 | <0.001 | |
Chronic obstructive pulmonary disease | 915 | 15.6 | 372 | 11.6 | 1287 | <0.001 | |
Cancer | 770 | 13.1 | 336 | 10.5 | 1106 | <0.001 | |
Lipid metabolism’s alteration | 392 | 6.7 | 226 | 7.1 | 618 | 0.490 | |
Neurological disease | 159 | 2.7 | 126 | 3.9 | 285 | 0.001 | |
Cardiovascular Risk Factors (Hypertension, Obesity, Diabetes) | 4516 | 77.0 | 2545 | 79.5 | 7061 | 0.005 | |
Vascular access | <0.001 | ||||||
AVF | 3078 | 52.5 | 1344 | 42.0 | 4422 | ||
CVC | >2790 | >47.6 | >1856 | >58.0 | >4646 | ||
Type of dialysis unit | 0.653 | ||||||
Public | 2201 | 37.5 | 1185 | 37.0 | 3386 | ||
Private | 3667 | 62.5 | 2015 | 63.0 | 5682 | ||
Pre-dialysis counselling | 0.052 | ||||||
Yes | 4386 | 74.7 | 2448 | 76.5 | 6834 | ||
No | 1482 | 25.3 | 750 | 23.4 | 2232 | ||
Laboratory findings, mean ± std | n | mean ± std | n | mean ± std | Total | p-value | |
Serum creatinine (mg/dL) | 5849 | 7.0 ± 2.3 | 3195 | 6.2 ± 2.0 | 9044 | <0.001 | |
Hb (g/dL) | 5865 | 10.3 ± 1.4 | 3198 | 10.1 ± 1.4 | 9063 | <0.001 | |
CPK (U/L) | 5868 | 8.7 ± 0.8 | 3200 | 8.7 ± 0.8 | 9068 | 0.009 | |
Serum phosphate level (mg/dL) | 5822 | 5.0 ± 1.4 | 3169 | 5.0 ± 1.4 | 8991 | 0.023 | |
Serum albumin (g/L) | 5840 | 3.6 ± 0.5 | 3185 | 3.5 ± 0.5 | 9025 | <0.001 |
AVF | CVC | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
N | N (%) | N (%) | Univariable Model | Multivariable Model * | |||||||
Gender | Estimate | 95% CI | p-Value | Estimate | 95% CI | p-Value | |||||
Male | 5868 | 3078 (52.5) | 2790 (47.6) | _ | _ | _ | _ | _ | _ | _ | _ |
Female | 3200 | 1344 (42.0) | 1856 (58.0) | 0.656 | 0.602 | 0.716 | <0.001 | 0.667 | 0.606 | 0.733 | <0.001 |
1 YEAR DEATH | |||||||||
---|---|---|---|---|---|---|---|---|---|
Dead | Alive | Total | p-Value * | ||||||
n | %col | %row | n | %col | %row | n | |||
Total | 1354 | 100 | 16.5 | 6861 | 100 | 83.5 | 8215 | ||
Gender | 0.2205 | ||||||||
Males | 855 | 63.2 | 16.1 | 4452 | 64.9 | 83.9 | 5307 | ||
Females | 499 | 36.9 | 17.2 | 2409 | 35.1 | 82.8 | 2908 | ||
Age (years) mean ± std | 1354 | 74.8 ± 10.9 | 6861 | 67.0 ± 14.5 | 8215 | ||||
Age class | (years) | <0.001 | |||||||
19–49 | 45 | 3.3 | 4.6 | 939 | 13.7 | 95.4 | 984 | ||
50–64 | 172 | 12.7 | 9.8 | 1576 | 23 | 90.2 | 1748 | ||
65–74 | 327 | 24.2 | 15.1 | 1835 | 26.8 | 84.9 | 2162 | ||
75–84 | 583 | 43.1 | 22.4 | 2019 | 29.4 | 77.6 | 2602 | ||
85+ | 227 | 16.8 | 31.6 | 492 | 7.2 | 68.4 | 719 | ||
Education qualification | <0.001 | ||||||||
No qualifications/Elementary School/Middle School | 992 | 73.3 | 18.2 | 4446 | 64.8 | 81.8 | 5438 | ||
High School/Degree and more | 362 | 26.7 | 13 | 2415 | 35.2 | 87 | 2777 | ||
Body Mass Index | <0.001 | ||||||||
Underweight (BMI < 18.0) | 118 | 8.7 | 26.8 | 323 | 4.7 | 73.2 | 441 | ||
Normal weight (18.0 ≤ BMI < 25.0) | 743 | 54.9 | 17.7 | 3449 | 50.3 | 82.3 | 4192 | ||
Overweight (25.0 ≤ BMI < 30.0) | 357 | 26.4 | 14.7 | 2079 | 30.3 | 85.3 | 2436 | ||
Obese (BMI ≥ 30.0) | 136 | 10 | 11.9 | 1010 | 14.7 | 88.1 | 1146 | ||
Self-sufficient | <0.001 | ||||||||
Complete | 247 | 18.2 | 6.6 | 3510 | 51.2 | 93.4 | 3757 | ||
Little self-sufficient | 397 | 29.3 | 16.2 | 2049 | 29.9 | 83.8 | 2446 | ||
Not self-sufficient | 710 | 52.4 | 35.3 | 1302 | 19 | 64.7 | 2012 | ||
Cause of ESRD | <0.001 | ||||||||
Unknown | 388 | 28.7 | 18.9 | 1668 | 24.3 | 81.1 | 2056 | ||
Diabetic nephropathy | 318 | 23.5 | 17.1 | 1542 | 22.5 | 82.9 | 1860 | ||
Renal vascular disease | 320 | 23.6 | 16.4 | 1629 | 23.7 | 83.6 | 1949 | ||
Glomerulonephritis | 45 | 3.3 | 7 | 602 | 8.8 | 93 | 647 | ||
Interstitial nephritis, toxic/pyelonephritis | 94 | 6.9 | 20.1 | 374 | 5.5 | 79.9 | 468 | ||
Other nephropathies | 74 | 5.5 | 20.7 | 284 | 4.1 | 79.3 | 358 | ||
Systemic disease | 83 | 6.1 | 28.5 | 208 | 3 | 71.5 | 291 | ||
Cystic renal disease/familial nephropathy | 28 | 2.1 | 5.1 | 523 | 7.6 | 94.9 | 551 | ||
Renal malformation | 4 | 0.3 | 11.4 | 31 | 0.5 | 88.6 | 35 | ||
Comorbidities | |||||||||
Heart disease | 683 | 50.4 | 22.7 | 2326 | 33.9 | 77.3 | 3009 | <0.001 | |
Peripheral vascular diseases | 242 | 17.9 | 25.9 | 692 | 10.1 | 74.1 | 934 | <0.001 | |
Cerebrovascular disease | 157 | 11.6 | 24.7 | 478 | 7 | 75.3 | 635 | <0.001 | |
Chronic obstructive pulmonary disease | 289 | 21.3 | 24.7 | 882 | 12.9 | 75.3 | 1171 | <0.001 | |
Cancer | 274 | 20.2 | 28.1 | 702 | 10.2 | 71.9 | 976 | <0.001 | |
Lipid metabolism’s alteration | 71 | 5.2 | 12.8 | 484 | 7.1 | 87.2 | 555 | 0.0153 | |
Neurological disease | 79 | 5.8 | 30 | 184 | 2.7 | 70 | 263 | <0.001 | |
Cardiovascular Risk Factors (Hypertension, Obesity, Diabetes) | 944 | 69.7 | 14.9 | 5414 | 78.9 | 85.2 | 6358 | <0.001 | |
Vascular access | <0.001 | ||||||||
FAV | 1043 | 77 | 25.1 | 3115 | 45.4 | 74.9 | 4158 | ||
CVC | 311 | 23 | 7.7 | 3746 | 54.6 | 92.3 | 4057 | ||
Type of dialysis unit | 0.2191 | ||||||||
Public hospital | 524 | 38.7 | 17.1 | 2534 | 36.9 | 82.9 | 3058 | ||
Private clinic | 830 | 61.3 | 16.1 | 4327 | 63.1 | 83.9 | 5157 | ||
Pre-dialysis counselling | 0.0003 | ||||||||
Yes | 975 | 72 | 15.7 | 5257 | 76.6 | 84.4 | 6232 | ||
No | 379 | 28 | 19.1 | 1604 | 23.4 | 80.9 | 1983 | ||
Laboratory findings, mean ± std | n | mean ± std | n | mean ± std | Total | p-value | |||
Serum creatinine (mg/dL) | 1349 | 6.0 ± 2.1 | 6845 | 6.9 ± 2.3 | 8194 | <0.001 | |||
Hb (g/dL) | 1352 | 9.9 ± 1.3 | 6859 | 10.3 ± 1.4 | 8211 | <0.001 | |||
CPK (U/L) | 1354 | 8.6 ± 0.8 | 6861 | 8.7 ± 0.8 | 8215 | <0.001 | |||
Serum phosphate level (mg/dL) | 1338 | 4.7 ± 1.4 | 6809 | 5.0 ± 1.4 | 8147 | <0.001 | |||
Serum albumin (g/L) | 1344 | 3.4 ± 0.5 | 6833 | 3.6 ± 0.5 | 8177 | <0.001 |
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Angelici, L.; Marino, C.; Umbro, I.; Bossola, M.; Calandrini, E.; Tazza, L.; Agabiti, N.; Davoli, M.; on behalf of the Regional Registry Dialysis and Transplant Lazio Region. Gender Disparities in Vascular Access and One-Year Mortality among Incident Hemodialysis Patients: An Epidemiological Study in Lazio Region, Italy. J. Clin. Med. 2021, 10, 5116. https://doi.org/10.3390/jcm10215116
Angelici L, Marino C, Umbro I, Bossola M, Calandrini E, Tazza L, Agabiti N, Davoli M, on behalf of the Regional Registry Dialysis and Transplant Lazio Region. Gender Disparities in Vascular Access and One-Year Mortality among Incident Hemodialysis Patients: An Epidemiological Study in Lazio Region, Italy. Journal of Clinical Medicine. 2021; 10(21):5116. https://doi.org/10.3390/jcm10215116
Chicago/Turabian StyleAngelici, Laura, Claudia Marino, Ilaria Umbro, Maurizio Bossola, Enrico Calandrini, Luigi Tazza, Nera Agabiti, Marina Davoli, and on behalf of the Regional Registry Dialysis and Transplant Lazio Region. 2021. "Gender Disparities in Vascular Access and One-Year Mortality among Incident Hemodialysis Patients: An Epidemiological Study in Lazio Region, Italy" Journal of Clinical Medicine 10, no. 21: 5116. https://doi.org/10.3390/jcm10215116