ArticleClinical and experimental nephrology2026
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.
Article in Clinical and experimental nephrology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundLower 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.
methodsWe 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.
resultsDuring 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.
conclusionsLower 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.
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