Grant: Travel Awards - Institute Community Support

Sex differences in survival among individuals treated with hemodialysis have been identified, with reduced survival in females compared to males. This may be related to sex-blind hemodialysis quality targets resulting in relative underdialysis in females potentially owing to lower volume of urea distribution. We sought to compare the associations between measures of hemodialysis quality and cardiovascular(CV) outcomes and mortality by sex. Electronic databases(Medline, EMBASE, CENTRAL) were searched from inception to August 2024. Randomized controlled trials and observational studies reporting measures of hemodialysis quality and CV-related hospitalizations, major adverse CV events(MACE), and mortality (CV, all-cause) in female and male adults treated with hemodialysis were included. Abstract, full-text screening, and data extraction were completed in duplicate. Results of included studies were synthesized following Synthesis Without Meta-analysis reporting guidelines. Of the 15,433 articles identified, 28 met inclusion criteria (n = 1,295,679 participants). Of included studies, 1 reported CV-related hospitalization, 1 reported MACE, 2 reported CV-related and 20 reported all-cause mortality. Kt/V was the most commonly reported exposure, with 1 study reporting decreased MACE, 5 studies reporting no association and 16 studies reporting decreased all-cause mortality with higher Kt/V in females. In males, 7 studies reported no association and 14 studies reported decreased all-cause mortality with higher Kt/V. Other hemodialysis quality measures demonstrated variability in associations with prespecified outcomes by sex. Limited studies have examined the associations between measures of hemodialysis quality and clinical outcomes by sex. Given sex-based differences in volume of distribution, further research examining sex-specific hemodialysis prescriptions is warranted.