Background: A survival advantage of women is observed in the general population. However, inconsistent findings have been reported regarding this advantage in patients undergoing maintenance hemodialysis. The aim of this study was to compare the risk of mortality, especially infection-related mortality, between male and female hemodialysis patients.Methods: A total of 3065 Japanese hemodialysis patients aged ≥18 years old were followed up for 10 years. Primary outcome was all-cause and

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... -related mortality. The association between the sex and these outcomes were examined using Cox proportional hazards models.Results: During the median follow-up of 8.8 years, 1498 patients died of any cause, and 387 died of infection. Compared with men, the multivariable-adjusted HRs (95% CIs) for all-cause and infection-related mortality in women were 0.51 (0.45–0.58) and 0.36 (0.27–0.47), respectively. This association remained significant even when the propensity score-matching or inverse probability of treatment weighting adjustment methods were employed. Furthermore, even when the non-infection-related mortality was considered a competing risk, the infection-related mortality rate in women was still significantly lower than that in men.Conclusions: A female survival advantage over men is observed in Japanese patients undergoing maintenance hemodialysis.