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Increased noncardiovascular mortality may explain the loss of the survival advantage of women on dialysis.Both young and diabetic women starting dialysis are at a higher mortality risk than equal men.
Stratification by diabetic nephropathy showed that diabetic women in all age categories remained at increased mortality risk compared with men, an effect mainly attributed to the noncardiovascular component.
Conclusions Mortality rates and causes of death in men and women on dialysis vary with age.
The data were obtained from Eurostat, the statistical office of the European Union (16,17).
Eurostat provides cause-specific mortality data, classified by International Statistical Classification of Diseases, 10th Revision (ICD-10) codes, stratified by 5-year age categories and sex (18).
For patients starting dialysis, this generally includes requesting informed consent for data collection within the framework of the registries and permission to send these data to the ERA-EDTA registry in an anonymous form.
For the study of mortality rates, the data were first stratified by 10-year age categories and sex.These observations may be limited, however, by the fact that none of these studies differentiate between pre- or postmenopausal states.Nonetheless, the reasons for this finding have not been fully investigated, and exploring more deeply the causes of the attenuation in the female survival advantage during dialysis may increase our understanding of the causes of the increased mortality risk in ESRD and potentially influence patient care (10).ESRD is associated with a markedly increased mortality risk, with CVD being the most common cause of death (11), as in the general population.We hypothesized that the cancellation of the survival advantage in women starting dialysis is primarily due to an excess mortality caused by cardiovascular causes (12).Additionally, we hypothesized that this effect differs across different age categories, because dialysis initiation at an early age would mean less life exposure to the purported beneficial effects of endogenous estrogen on the cardiac system (13,14).Therefore, our objective was to study cardiovascular and noncardiovascular mortality rates, relative risks, and hazard ratios in relation to sex and age in a large cohort of European patients receiving dialysis.In the general population, women have a longer life expectancy than men (1), which can be partly attributed to a lower prevalence of cardiovascular risk factors and cardiovascular disease (CVD) in women.Women have also been found to have a longer life expectancy in populations with manifest atherosclerosis (2–6).The ERA-EDTA Registry collects data on renal replacement therapy through national and regional registries in Europe, including date of birth, sex, primary renal disease, date of start of therapy, subsequent changes in treatment modality, and date and cause of death.Patients were included if they originated from registries reporting less than 25% missing or unknown causes of death.