Category: Other -
Objective : Hypertension and chronic kidney disease are two of the most important risk factors for cardiovascular disease, a major cause of death in the US population. The impact of gender in this equation remains unclear, more so, on how it affects the different races. Studies comparing the outcomes and differences in inpatient mortality between males and females with hypertension and CKD are sparse. Our aim was to determine if gender in the US population and menopausal age, affect the inpatient survival rate among hypertensive patients across different CKD stages.
Methods : Data was extracted from the 2005 to 2012 Nationwide Inpatient Sample (NIS). Using propensity score matching, female hypertensive with chronic kidney disease (stage 3, 4, 5 or ESRD) patients were matched with hypertensive males at a 1:1 ratio. We compared inpatient mortality, both crude mortality and mortality per CKD stage, menopausal age, length of stay and total hospital charges between male and females of different Races. Analyses were performed using SAS version 9.3 (SAS Institute, Cary, NC, USA).
Among 2,121,750 hospitalized hypertensive patients, 1,092,931 (51.51%) were males and 1,028,819 (48.49%) females. There was 32.09% females with CKD3, 14.69% with CKD4, 3.37% CKD5 and 54.10% with ESRD. On the other side, 32.69% of males have CKD3, 13.22% CKD4, 3.16% CKD5 and 50.93% with ESRD. In-hospital crude mortality was significantly higher for males compared to a matched group of females at CKD stages 3 to 5 (3.09 vs 3.29% p<0.0001 for CKD3; 4.05 vs 4.36% p=0.0004 in CKD4) but was non-significant in ESRD (4.68 vs 4.83% p= 0.45).
Factoring menopausal age for each race group, we find women 50y have similar mortality rate to men with CKD 3, 4 or 5; while women > 50y with ESRD have a significantly higher mortality than ESRD men of similar race group.
Inpatient mortality risk of women compared to men through stages of CKD 3 to 6, appears to be reduced in pre-menopausal women, comparable after menopause and increased when on dialysis, irrespective of the race group.
Conclusion : Further studies are needed to elucidate the possible links of menopause and the effect of gender with mortality in patients with hypertension and CKD and to assess if this holds true in outpatient settings.
Ghada Elshimy– Endocrinology Fellow 1st year, University of Arizona College of Medicine, Phoenix, Phoenix, Arizona
Ricardo Correa– Endocrinology, diabetes and metabolism fellowship director, University of Arizona College of Medicine-Phoenix and Phoenix VA, Phoenix, Arizona
Endocrinology Fellow 1st year
University of Arizona College of Medicine, Phoenix
Endocrinology, diabetes and metabolism fellowship director
University of Arizona College of Medicine-Phoenix and Phoenix VA
Ricardo Correa, M.D., Es. D., F.A.C.P., C.M.Q. is an Assistant Professor of Medicine and Program Director for the Endocrinology, Diabetes and Metabolism of the University of Arizona College of Medicine-Phoenix and the Warren Alpert Medical School of Brown University in the department of Endocrinology, Diabetes and Metabolism. He is the chair of the young physician subcommittee of the American Association of Clinical Endocrinologist (YPS-AACE). Also he is editor of Dynamed and outreach unit director of Endotext.org and Thyroid manager and editorial board of multiple endocrine and internal medicine journals.
He completed his Medical School and Education Master at University of Panama. He completed a research fellowship in Epidemiology and Tropical disease at ICGES in Panama City and his internal medicine residency at Jackson Memorial hospital-University of Miami (UM) program. In 2012, he was honored with the AOA and GoldDOC Award from the UM. Then he pursued his clinical and research fellowship in endocrinology with special focus in neuroendocrinology and adrenals at National Institute of Health.
He was trained in Evidence-based Medicine at McMaster University in Canada and in Editorial process and OJS by LATINDEX. He is co-director of the Panamanian Cochrane Center and EBM advocate.
Dr. Correa has been involved in organized medicine since medical school. He has been scientific committee chair and vice speaker for the AMA-RFS, chair of the CoA for the ACP FC, Board of Trustee of the Maryland Medical Society, National Secretary of the CoA for the NHMA, Regional Vice President of the CIR, Medical Education Officer of JDN-WMA. He has been involved with local, regional and national organization in the area of medical education, leadership and physician wellbeing including the AMA joy in medicine organization, ACGME at different level including the duty hour task force, NBME as part of the board, NBPAS and other organization.
At AACE and ACE and Endocrine Society, Dr. Correa has occupied different position from been the fellow-in-training board of director member to member and advisor of multiple committees throughout the years.
Dr. Correa has been involved in multiple academic, scientific and educational activities including article Consultant, Interpretation of the Medical Literature Project, NBME, International Committee member of the Committee on publications ethics (COPE), World Association of Medical Editors, Deputy Editor of International Archives of Medicine, Editorial board and peer reviewer of multiple journals including Annals of Public Health, PAHO journal, SGIM journal, International Journal of Endocrinology, International Journal of Diabetes, International Journal of Clinical Cases and Images, International journal of case reports, etc. Also he is consultant for Latinamerican science center including Bolivia and Panama national science department.
He is board certified in Medical Quality. He is the author of the book title “Case report: basics and publication”. His research is focus on neuroendocrinology mainly on pituitary and adrenal tumor and new genetic mutations.