SO061SEX DIFFERENCES IN MORTALITY AMONG PEOPLE WITH END-STAGE KIDNEY DISEASE: DO WOMEN ALWAYS LIVE LONGER?

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Nicole De La Mata ◽  
Grace Macleod ◽  
Patrick Kelly ◽  
Brenda Rosales ◽  
Philip Masson ◽  
...  
Keyword(s):  
Sex Differences ◽  
Kidney Transplantation ◽  
General Population ◽  
Excess Mortality ◽  
Relative Survival ◽  
Average Life ◽  
End Stage Kidney Disease ◽  
Life Years ◽  
Life Years Lost ◽  
End Stage

Abstract Background and Aims Female life expectancies consistently exceed males in the general population. Yet, this survival advantage may not persist in the presence of a chronic disease due to sex-based differences or healthcare inequities. We aimed to explore sex differences in survival among people with end-stage kidney disease (ESKD) compared to the general population. Method We included the entire ESKD population in Australia, 1980-2013 and New Zealand, 1988-2012 from the Australian and New Zealand Dialysis and Transplant Registry. These were linked to national death registers to ascertain deaths and their causes. We estimated relative measures of survival, including standardized mortality ratios (SMR), cumulative relative survival and expected life years lost, using general population data (adjusting for country, age, sex and calendar year) to account for background mortality. Results Of the 60,823 ESKD patients, there were 25,042 females (41%) and 35,781 males (59%). Overall 34,417 deaths occurred over the 368,719 person-years of follow-up where a similar proportion of females (57%) and males (56%) died. While mortality sex differences within the ESKD population were minor, once compared to the general population female ESKD patients had greater excess deaths, worse relative survival and greater life years lost compared to male ESKD patients. Female ESKD patients had 12 times (SMR:11.5; 95%CI:11.3-11.7) and males had 7 times (SMR:6.7; 95%CI:6.7-6.8) the expected deaths, with the greatest sex disparity among younger ages and from cardiovascular disease. Relative survival was consistently lower in females (0.57, 95%CI:0.57-0.58 in males vs 0.54, 95%CI:0.54-0.55 in females at 5 years), where the excess mortality was 9% higher (95%CI:7-12%) in female ESKD patients (Fig 1A), adjusting for year and age. The average life years lost for female ESKD patients was 4-5 years greater than male ESKD patients (Average life years lost 25.9 years, 95%CI:25.1-26.7 in males and 31.4 years, 95%CI:30.5-32.1 in females aged 15 years at ESKD) (Fig 1B). Kidney transplantation reduced the sex differences in excess mortality, with similar relative survival (p=0.42; Fig 1C) and average life years lost reduced to 3-4 years for females (Fig 1D). Conclusion The impact of ESKD is more profound for women than men with greater excess mortality, however kidney transplantation attenuates these differences. Our findings show that chronic diseases and sex can compound to produce worse outcomes where women lose their survival advantage in the presence of ESKD.

scholarly journals Sex Differences in Mortality Among People with End-Stage Kidney Disease: Bi-National Data-Linkage Cohort Study

2020 ◽  
Vol 5 (5) ◽  
Author(s):  
Nicole L De La Mata ◽  
Grace Macleod ◽  
Patrick J Kelly ◽  
Brenda Rosales ◽  
Philip Masson ◽  
...  
Keyword(s):  
Sex Differences ◽  
General Population ◽  
Excess Mortality ◽  
Data Linkage ◽  
Relative Survival ◽  
Average Life ◽  
End Stage Kidney Disease ◽  
Life Years ◽  
Life Years Lost ◽  
End Stage

IntroductionFemale life expectancies consistently exceed males in the general population. Yet, this survival advantage may not persist in the presence of a chronic disease due to biological differences or healthcare inequities. Objectives and ApproachWe aimed to explore sex differences in mortality among people with end-stage kidney disease (ESKD). T he entire ESKD population in Australia, 1980-2013, and New Zealand,1988-2012, were included from the Australian and New Zealand Dialysis and Transplant Registry. Data linkage to national death registers was undertaken to ascertain deaths and their causes. We estimated relative measures of survival, including standardized mortality ratios (SMR), relative survival and expected life years lost, using general population data to account for background mortality, adjusting for country, age, sex and year. ResultsOf 60,823 ESKD patients, there were 25,042 females (41%) and 35,781 males (59%). Mortality sex differences within the ESKD population were minor, but once compared to the general population, female ESKD patients had more excess deaths, worse relative survival and greater life years lost compared to male ESKD patients. Females had 11.5 SMR (95%CI:11.3-11.7) and males had 6.7 SMR (95%CI:6.7-6.8), with greater disparity among younger ages and from certain causes. Relative survival was consistently lower in females, with adjusted excess mortality 9% higher (95%CI:7-12%) in ESKD females. Average life years lost was 4-5 years greater in ESKD females compared to males across all ages. Kidney transplantation reduced the sex differences in excess mortality, with similar relative survival (p=0.42) and average life years lost reduced to 3-4 years for females. Conclusion / ImplicationsThe impact of ESKD is more profound for women than men with greater excess mortality, however kidney transplantation attenuates these differences. Our findings show that chronic diseases and sex can compound to produce worse outcomes where women lose their survival advantage in the presence of ESKD.

scholarly journals Excess mortality and life-years lost in people with bipolar disorder: an 11-year population-based cohort study

2021 ◽  
Vol 30 ◽  
Author(s):  
J. K. N. Chan ◽  
C. S. M. Wong ◽  
N. C. L. Yung ◽  
E. Y. H. Chen ◽  
W. C. Chang
Keyword(s):  
Bipolar Disorder ◽  
Cohort Study ◽  
General Population ◽  
Excess Mortality ◽  
Premature Mortality ◽  
Population Based ◽  
Targeted Interventions ◽  
Life Years ◽  
Life Years Lost ◽  
Over Time

Abstract Aims Bipolar disorder is associated with premature mortality, but evidence is mostly derived from Western countries. There has been no research evaluating shortened lifespan in bipolar disorder using life-years lost (LYLs), which is a recently developed mortality metric taking into account illness onset for life expectancy estimation. The current study aimed to examine the extent of premature mortality in bipolar disorder patients relative to the general population in Hong Kong (HK) in terms of standardised mortality ratio (SMR) and excess LYLs, and changes of mortality rate over time. Methods This population-based cohort study investigated excess mortality in 12 556 bipolar disorder patients between 2008 and 2018, by estimating all-cause and cause-specific SMRs, and LYLs. Trends in annual SMRs over the 11-year study period were assessed. Study data were retrieved from a territory-wide medical-record database of HK public healthcare services. Results Patients had higher all-cause [SMR: 2.60 (95% CI: 2.45–2.76)], natural-cause [SMR: 1.90 (95% CI: 1.76–2.05)] and unnatural-cause [SMR: 8.63 (95% CI: 7.34–10.03)] mortality rates than the general population. Respiratory diseases, cardiovascular diseases and cancers accounted for the majority of deaths. Men and women with bipolar disorder had 6.78 (95% CI: 6.00–7.84) years and 7.35 (95% CI: 6.75–8.06) years of excess LYLs, respectively. The overall mortality gap remained similar over time, albeit slightly improved in men with bipolar disorder. Conclusions Bipolar disorder is associated with increased premature mortality and substantially reduced lifespan in a predominantly Chinese population, with excess deaths mainly attributed to natural causes. Persistent mortality gap underscores an urgent need for targeted interventions to improve physical health of patients with bipolar disorder.

scholarly journals Patterns of Survival Among Patients With Myeloproliferative Neoplasms Diagnosed in Sweden From 1973 to 2008: A Population-Based Study

2012 ◽  
Vol 30 (24) ◽  
pp. 2995-3001 ◽  
Author(s):  
Malin Hultcrantz ◽  
Sigurdur Yngvi Kristinsson ◽  
Therese M.-L. Andersson ◽  
Ola Landgren ◽  
Sandra Eloranta ◽  
...  
Keyword(s):  
General Population ◽  
Life Expectancy ◽  
Excess Mortality ◽  
Myeloproliferative Neoplasms ◽  
Treatment Options ◽  
Large Population ◽  
Relative Survival ◽  
Population Based ◽  
Population Based Study ◽  
Over Time

PurposeReported survival in patients with myeloproliferative neoplasms (MPNs) shows great variation. Patients with primary myelofibrosis (PMF) have substantially reduced life expectancy, whereas patients with polycythemia vera (PV) and essential thrombocythemia (ET) have moderately reduced survival in most, but not all, studies. We conducted a large population-based study to establish patterns of survival in more than 9,000 patients with MPNs.Patients and MethodsWe identified 9,384 patients with MPNs (from the Swedish Cancer Register) diagnosed from 1973 to 2008 (divided into four calendar periods) with follow-up to 2009. Relative survival ratios (RSRs) and excess mortality rate ratios were computed as measures of survival.ResultsPatient survival was considerably lower in all MPN subtypes compared with expected survival in the general population, reflected in 10-year RSRs of 0.64 (95% CI, 0.62 to 0.67) in patients with PV, 0.68 (95% CI, 0.64 to 0.71) in those with ET, and 0.21 (95% CI, 0.18 to 0.25) in those with PMF. Excess mortality was observed in patients with any MPN subtype during all four calendar periods (P < .001). Survival improved significantly over time (P < .001); however, the improvement was less pronounced after the year 2000 and was confined to patients with PV and ET.ConclusionWe found patients with any MPN subtype to have significantly reduced life expectancy compared with the general population. The improvement over time is most likely explained by better overall clinical management of patients with MPN. The decreased life expectancy even in the most recent calendar period emphasizes the need for new treatment options for these patients.

Trajectories of glomerular filtration rate and progression to end stage kidney disease after kidney transplantation

2021 ◽  
Vol 99 (1) ◽  
pp. 186-197 ◽  
Author(s):  
Marc Raynaud ◽  
Olivier Aubert ◽  
Peter P. Reese ◽  
Yassine Bouatou ◽  
Maarten Naesens ◽  
...  
Keyword(s):  
Glomerular Filtration Rate ◽  
Kidney Transplantation ◽  
Kidney Disease ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
End Stage Kidney Disease ◽  
End Stage

scholarly journals Direct modeling of the crude probability of cancer death and the number of life years lost due to cancer without the need of cause of death: a pseudo-observation approach in the relative survival setting

Biostatistics ◽  
2020 ◽  
Author(s):  
Dimitra-Kleio Kipourou ◽  
Maja Pohar Perme ◽  
Bernard Rachet ◽  
Aurelien Belot
Keyword(s):  
Cause Of Death ◽  
Relative Survival ◽  
Population Based ◽  
Subdistribution Hazard ◽  
Cancer Data ◽  
Regression Parameters ◽  
Life Years ◽  
Direct Modeling ◽  
Life Years Lost ◽  
Probability Of Cancer

Summary In population-based cancer studies, net survival is a crucial measure for population comparison purposes. However, alternative measures, namely the crude probability of death (CPr) and the number of life years lost (LYL) due to death according to different causes, are useful as complementary measures for reflecting different dimensions in terms of prognosis, treatment choice, or development of a control strategy. When the cause of death (COD) information is available, both measures can be estimated in competing risks setting using either cause-specific or subdistribution hazard regression models or with the pseudo-observation approach through direct modeling. We extended the pseudo-observation approach in order to model the CPr and the LYL due to different causes when information on COD is unavailable or unreliable (i.e., in relative survival setting). In a simulation study, we assessed the performance of the proposed approach in estimating regression parameters and examined models with different link functions that can provide an easier interpretation of the parameters. We showed that the pseudo-observation approach performs well for both measures and we illustrated their use on cervical cancer data from the England population-based cancer registry. A tutorial showing how to implement the method in R software is also provided.

scholarly journals Death From Stroke in End-Stage Kidney Disease

Stroke ◽  
2019 ◽  
Vol 50 (2) ◽  
pp. 487-490 ◽  
Author(s):  
Nicole L. De La Mata ◽  
Philip Masson ◽  
Rustam Al-Shahi Salman ◽  
Patrick J. Kelly ◽  
Angela C. Webster
Keyword(s):  
Kidney Disease ◽  
General Population ◽  
Standardized Mortality Ratio ◽  
Stroke Mortality ◽  
End Stage Kidney Disease ◽  
Mortality Ratio ◽  
Standardized Mortality Ratios ◽  
Using Data ◽  
End Stage ◽  
Over Time

Background and Purpose— People with end-stage kidney disease (ESKD) are at greater risk of stroke. We aimed to compare stroke mortality between the ESKD population and the general population. Methods— We included all patients with incident ESKD in Australia, 1980 to 2013, and New Zealand, 1988 to 2012. The primary cause of death was ascertained using data linkage with national death registers. We produced standardized mortality ratios for stroke deaths, by age, sex, and calendar year. Results— We included 60 823 patients with ESKD, where 941 stroke deaths occurred during 381 874 person-years. Patients with ESKD had >3× the stroke deaths compared with the general population (standardized mortality ratio, 3.4; 95% CI, 3.2–3.6), markedly higher in younger people and women. The greatest excess was in intracerebral hemorrhages (standardized mortality ratio, 5.2; 95% CI, 4.5–5.9). Excess stroke deaths in patients with ESKD decreased over time, although were still double in 2013 (2013 standardized mortality ratio, 2.1; 95% CI, 1.5–2.9). Conclusions— People with ESKD experience much greater stroke mortality with the greatest difference for women and younger people. However, mortality has improved over time.

scholarly journals FUNCTIONAL INDEPENDENCE, ACCESS TO KIDNEY TRANSPLANTATION, AND WAITLIST MORTALITY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S494-S495
Author(s):  
Nadia M Chu ◽  
Stephanie Sison ◽  
Abimereki Muzaale ◽  
Christine Haugen ◽  
Jacqueline Garonzik Wang ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Kidney Disease ◽  
Activities Of Daily Living ◽  
Competing Risks ◽  
Mortality Risk ◽  
Daily Living ◽  
Functional Independence ◽  
End Stage Kidney Disease ◽  
End Stage ◽  
Waitlist Mortality

Abstract Although functional independence is a health priority for patients with advanced CKD, 50% of those who progress to end-stage kidney disease (ESKD) develop difficulties carrying-out essential day-to-day activities. Functional independence is not routinely assessed at kidney transplant (KT) evaluation; therefore, it is unclear what percentage of candidates are functionally independent and whether independence is associated with access to KT and waitlist mortality. We studied a prospective cohort of 3,168 ESKD participants (1/2009-6/2018) who self-reported functional independence in basic Activities of Daily Living (ADL) and more complex Instrumental Activities of Daily Living (IADL). We estimated adjusted associations between functional independence (separately) and listing (Cox), waitlist mortality (competing risks), and transplant rates (Poisson). At evaluation, 92.4% were independent in ADLs, but only 68.5% were independent in IADLs. Functionally independent participants had a higher chance of listing for KT (ADL:aHR=1.55,95%CI:1.30-1.87; IADL:aHR=1.39,95%CI 1.26-1.52). Among KT candidates, ADL independence was associated with lower waitlist mortality risk (SHR=0.66,95%CI:0.44-0.98) and higher rate of KT (IRR=1.58,95%CI:1.12-2.22); the same was not observed for IADL independence (SHR=0.86,95%CI:0.65-1.12; IRR=1.01,95%CI:0.97-1.19). ADL independence was associated with better KT access and lower waitlist mortality; clinicians should screen KT candidates for ADL independence, and identify interventions to maintain independence to improve waitlist outcomes.

Channels of being informed about kidney transplantation centers for patients with end stage kidney disease

2012 ◽  
Vol 28 (1) ◽  
pp. 26
Author(s):  
Alp Gurkan ◽  
Yildirim B. Gulhan ◽  
Suleyman Tilif ◽  
Yeliz Gul
Keyword(s):  
Kidney Transplantation ◽  
Kidney Disease ◽  
End Stage Kidney Disease ◽  
End Stage

scholarly journals CLINICAL CASE OF ABO INCOMPATIBLEKIDNEYTRANSPLANTATTHE О. SHALIMOV’S NATIONAL INSTITUTE OFSURGERYAND TRANSPLANTOLOGYIN UKRAINE

2015 ◽  
pp. 45-48
Author(s):  
R. Zograbian ◽  
V. Zakordonets ◽  
A. Malik ◽  
O. Zakrutko ◽  
L. Tarasenko
Keyword(s):  
Kidney Transplantation ◽  
End Stage Kidney Disease ◽  
Successful Case ◽  
Increased Risk ◽  
The Family ◽  
Related Donor ◽  
Cadaveric Organ ◽  
End Stage ◽  
Living Related ◽  
Living Related Donor

Kidney transplantation is the gold standard for treating end - stage kidney disease. But the lack of cadaveric organ donation in Ukraine makes this operation available only for patients with living related donor. The absence of ABO - compatible living donor in the family is found in 20 - 30% of cases. This is the case for ABO - incompatible transplantation, but it is associated with an increased risk of acute rejection and requires special pre - transplant management. The article describes the first in Ukraine successful case of ABO - incompatible kidney transplantation in A.A. Shalimov’s National Institute of Surgery and Transplantology.

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