Mortality,health-related quality of life,and depression symptoms in younger and older men and women undergoing hemodialysis

Abstract

Background and objective:

Some studies on maintenance hemodialysis (MHD) patients report a longer survival, albeit with poorer health-related quality of life (HRQoL), and more depression symptoms in women than in men. Whether these gender differences vary with age is uncertain. We tested the associations of gender with mortality, depression symptoms, and HRQoL in MHD patients of different age groups.

Methods:

We used data from 1504 adult MHD patients enrolled in the PROHEMO, a prospective cohort in Salvador, Brazil. The KDQOL-SF was used for the component summaries of the mental (MCS) and physical (PCS) HRQoL scales. Depression symptoms were assessed by the complete version of the Center for Epidemiological Studies Depression Screening Index (CES-D). To test for gender differences, extensively adjusted linear models were used for depression and HRQoL scores, and Cox models for death hazard ratio (HR).

Results:

Women reported worse HRQoL than men, particularly for ages ⩾60 years. In the age group ⩾60 years, the adjusted difference (AD) in score was −3.45; 95% CI: −6.81, −0.70 for MCS −3.16; −5.72, −0.60 for PCS. Older (⩾60 years) women also had more depression symptoms (AD 4.98; 2.33, 7.64). Mortality was slightly lower in women than in men with an adjusted HR of 0.89 (0.71, 1.11) and consistent across age categories.

Conclusions:

In a sample of Brazilian MHD patients, women had a slightly lower mortality, albeit with more depression symptoms and poorer HRQoL than men, particularly among older patients. This study highlights the need to investigate gender inequalities for MHD patients across different cultures and populations.

Keywords

Hemodialysis chronic kidney disease mortality depression quality of life

Get full access to this article

View all access options for this article.

References

Belon

Lima

Barros

MB.

Gender differences in healthy life expectancy among Brazilian elderly. Health Qual Life Outcomes 2014; 12: 1–10.

Schünemann

Strulik

Trimborn

The gender gap in mortality: how much is explained by behavior?

J Health Econ 2017; 54: 79–90.

Bobak

Relative and absolute gender gap in all-cause mortality in Europe and the contribution of smoking. Eur J Epidemiol 2003; 18: 15–18.

Vongsanim

Davenport

The effect of gender on survival for hemodialysis patients: why don’t women live longer than men?

Semin Dial 2019; 32: 438–443.

Hecking

Bieber

Ethier

, et al. Sex-specific differences in hemodialysis prevalence and practices and the male-to-female mortality rate: the dialysis outcomes and practice patterns study (DOPPS). PLoS Med 2014; 11: e1001750.

Crimmins

Shim

Zhang

, et al. Differences between men and women in mortality and the health dimensions of the morbidity process. Clin Chem 2019; 65: 135–145.

Salk

Hyde

Abramson

LY.

Gender differences in depression in representative national samples: meta-analyses of diagnoses and symptoms. Psychol Bull 2017; 143: 783–822.

Lopes

Bragg-Gresham

Goodkin

, et al. Factors associated with health-related quality of life among hemodialysis patients in the DOPPS. Qual Life Res 2007; 16: 545–557.

Lopes

Matos

Leite

, et al. Depression as a potential explanation for gender differences in health-related quality of life among patients on maintenance hemodialysis. Nephron Clin Pract 2010; 115: c35–c40.

10.

Lopes

Albert

Young

, et al. Screening for depression in hemodialysis patients: associations with diagnosis, treatment, and outcomes in the DOPPS. Kidney Int 2004; 66: 2047–2053.

11.

Sood

Rigatto

Komenda

, et al. Mortality risk for women on chronic hemodialysis differs by age. Can J Kidney Health Dis 2014; 1: 10.

12.

Hajian-Tilaki

Heidari

Hajian-Tilaki

Are gender differences in health-related quality of life attributable to sociodemographic characteristics and chronic disease conditions in elderly people?

Int J Prev Med 2017; 8: 95.

13.

Azevedo

ES.

Subgroup studies of black admixture within a mixed population of Bahia, Brazil. Ann Hum Genet 1980; 44: 55–60.

14.

Krieger

Morton

, et al. Racial admixture in north-eastern Brazil. Ann Hum Genet 1965; 29: 113–125.

15.

Associação Brasileira de Empresas de Pesquisa (ABEP). Critério Padrão de Classificação Econômica Brasil/2008. https://aba.com.br/wp-content/uploads/content/7727632a373615b34f2a5726fcc5c9e2.pdf (2008, accessed 8 July 2021).

16.

Duarte

Ciconelli

Sesso

Cultural adaptation and validation of the “Kidney Disease and Quality of Life–Short Form (KDQOL-SF 1.3)” in Brazil. Braz J Med Biol Res 2005; 38: 261–270.

17.

Silveira

Jorge

MR.

Propriedades psicométricas da escala de rastreamento populacional para depressão CES-D em populações clínica e não clínica de adolescentes e adultos jovens. Psiq Clin 1998; 25: 251–261.

18.

Ware

Kosinski

Keller

SD.

SF-36 Physical and mental health summary scales: a user’s manual. Boston, MA: New England Medical Center – The Health Institute, 1994.

19.

Hedayati

Bosworth

Kuchibhatla

, et al. The predictive value of self-report scales compared with physician diagnosis of depression in hemodialysis patients. Kidney Int 2006; 69: 1662–1668.

20.

Hays

Woolley

JM.

The concept of clinically meaningful difference in health-related quality-of-life research. How meaningful is it?

Pharmacoeconomics 2000; 18: 419–423.

21.

Tietjen

Brandes

Digre

, et al. High prevalence of somatic symptoms and depression in women with disabling chronic headache. Neurology 2007; 68: 134–140.

22.

Munce

Stewart

DE.

Gender differences in depression and chronic pain conditions in a national epidemiologic survey. Psychosomatics 2007; 48: 394–399.

23.

Gottlieb

Khatta

Friedmann

, et al. The influence of age, gender, and race on the prevalence of depression in heart failure patients. J Am Coll Cardiol 2004; 43: 1542–1549.

24.

Holbrook

Hoyt

DB.

The impact of major trauma: quality-of-life outcomes are worse in women than in men, independent of mechanism and injury severity. J Trauma 2004; 56: 284–290.

25.

Lunsky

Depressive symptoms in intellectual disability: does gender play a role?

J Intellect Disabil Res 2003; 47: 417–427.

26.

Hankin

Abramson

LY.

Development of gender differences in depression: an elaborated cognitive vulnerability-transactional stress theory. Psychol Bull 2001; 127: 773–796.

27.

Almeida-Filho

Lessa

Magalhaes

, et al. Social inequality and depressive disorders in Bahia, Brazil: interactions of gender, ethnicity, and social class. Soc Sci Med 2004; 59: 1339–1353.

28.

Barry

Allore

Guo

, et al. Higher burden of depression among older women: the effect of onset, persistence, and mortality over time. Arch Gen Psychiatry 2008; 65: 172–178.

29.

Gomes Neto

de Lacerda

FFR

Lopes

, et al. Intradialytic exercise training modalities on physical functioning and health-related quality of life in patients undergoing maintenance hemodialysis: systematic review and meta-analysis. Clin Rehabil 2018; 32: 1189–1202.

30.

Lii

Tsay

Wang

TJ.

Group intervention to improve quality of life in haemodialysis patients. J Clin Nurs 2007; 16: 268–275.

31.

Duarte

Miyazaki

Blay

, et al. Cognitive-behavioral group therapy is an effective treatment for major depression in hemodialysis patients. Kidney Int 2009; 76: 414–421.

32.

Wang

Seow

Chow

WL.

Influence of ethnicity on health-related quality of life of hemodialysis patients in Singapore. Int J Artif Organs 2012; 35: 217–225.

33.

Lopes

Bragg-Gresham

Satayathum

, et al. Health-related quality of life and associated outcomes among hemodialysis patients of different ethnicities in the United States: the dialysis outcomes and practice patterns study (DOPPS). Am J Kidney Dis 2003; 41: 605–615.

34.

Fukuhara

Lopes

Bragg-Gresham

, et al. Health-related quality of life among dialysis patients on three continents: the dialysis outcomes and practice patterns study. Kidney Int 2003; 64: 1903–1910.

35.

Lopes

Lantz

Morgenstern

, et al. Associations of self-reported physical activity types and levels with quality of life, depression symptoms, and mortality in hemodialysis patients: the DOPPS. Clin J Am Soc Nephrol 2014; 9: 1702–1712.