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Войти в исследования Clinical and experimental nephrology · 2026
Sex differences in the association between corrected serum calcium and sudden death in patients undergoing maintenance hemodialysis: ten-year outcomes of the Q-cohort study.
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Hiyamuta Hiroto, Yamada Shunsuke, Matsui Rei, Taniguchi Masatomo, Tsuruya Kazuhiko, Nakano Toshiaki, Ago Tetsuro
Аннотация
BACKGROUND: Lower serum calcium (Ca) levels may increase arrhythmogenic vulnerability in patients undergoing hemodialysis, but whether this association differs by sex remains unclear. We examined the sex-specific association between corrected serum Ca and sudden death in a multicenter hemodialysis cohort.
METHODS: We analyzed 3,505 Japanese patients undergoing maintenance hemodialysis in the Q-Cohort Study. Baseline corrected serum Ca was evaluated as a 1-standard deviation (SD) increase and as low corrected serum Ca, primarily defined as < 8.4 mg/dL. The primary outcome was sudden death. Cox proportional hazards and Fine-Gray competing-risk models were used, with non-sudden death treated as a competing event. The primary analysis tested the interaction between corrected serum Ca and sex.
RESULTS: During follow-up, 227 sudden deaths occurred among 1,426 women and 2,079 men. Median corrected serum Ca was 9.4 mg/dL, and 211 patients had corrected serum Ca < 8.4 mg/dL. In the extended Cox model, higher corrected serum Ca was associated with lower sudden death risk in women (hazard ratio [HR] per 1-SD increase, 0.596; 95% confidence interval [CI], 0.464-0.766; P < 0.001), but not in men (HR, 1.04; 95% CI, 0.877-1.23; P = 0.663). The corrected serum Ca-by-male sex interaction was significant (HR, 1.74; 95% CI, 1.29-2.34; P < 0.001). Similar findings were observed in Fine-Gray models and sensitivity analyses.
CONCLUSIONS: Lower corrected serum Ca was associated with higher sudden death risk primarily in women. Sex may modify the prognostic significance of corrected serum Ca for sudden death risk stratification.
METHODS: We analyzed 3,505 Japanese patients undergoing maintenance hemodialysis in the Q-Cohort Study. Baseline corrected serum Ca was evaluated as a 1-standard deviation (SD) increase and as low corrected serum Ca, primarily defined as < 8.4 mg/dL. The primary outcome was sudden death. Cox proportional hazards and Fine-Gray competing-risk models were used, with non-sudden death treated as a competing event. The primary analysis tested the interaction between corrected serum Ca and sex.
RESULTS: During follow-up, 227 sudden deaths occurred among 1,426 women and 2,079 men. Median corrected serum Ca was 9.4 mg/dL, and 211 patients had corrected serum Ca < 8.4 mg/dL. In the extended Cox model, higher corrected serum Ca was associated with lower sudden death risk in women (hazard ratio [HR] per 1-SD increase, 0.596; 95% confidence interval [CI], 0.464-0.766; P < 0.001), but not in men (HR, 1.04; 95% CI, 0.877-1.23; P = 0.663). The corrected serum Ca-by-male sex interaction was significant (HR, 1.74; 95% CI, 1.29-2.34; P < 0.001). Similar findings were observed in Fine-Gray models and sensitivity analyses.
CONCLUSIONS: Lower corrected serum Ca was associated with higher sudden death risk primarily in women. Sex may modify the prognostic significance of corrected serum Ca for sudden death risk stratification.