Sex differences in acute kidney injury requiring dialysis

被引:95
作者
Neugarten, Joel [1 ]
Golestaneh, Ladan [1 ]
Kolhe, Nitin V. [2 ]
机构
[1] Albert Einstein Coll Med, Dept Med, Div Nephrol, Montefiore Med Ctr, 111 E 210 St, Bronx, NY 10467 USA
[2] Royal Derby Hosp, Dept Renal Med, Uttoxeter Rd, Derby DE22 3NE, England
关键词
Gender; Sex; Acute kidney injury; Acute renal failure; AKI; RENAL REPLACEMENT THERAPY; CRITICALLY-ILL PATIENTS; ISCHEMIA-REPERFUSION INJURY; FAILURE; GENDER; RISK; SURVIVAL; AKI; PROGRESSION; INITIATION;
D O I
10.1186/s12882-018-0937-y
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Background: Female sex has been included as a risk factor in models developed to predict the risk of acute kidney injury (AKI) associated with cardiac surgery, aminoglycoside nephrotoxicity and contrast-induced nephropathy. The commentary acompanying the Kidney Disease Improving Global Outcomes Clinical Practice Guideline for Acute Kidney Injury concludes that female sex is a shared susceptibility factor for acute kidney injury based on observations that female sex is associated with the development of hospital-acquired acute kidney injury. In contrast, female sex is reno-protective in animal models. In this context, we sought to examine the role of sex in hospital-associated acute kidney injury in greater detail. Methods: We utilized the Hospital Episode Statistics database to calculate the sex-stratified incidence of AKI requiring renal replacement therapy (AKI-D) among 194,157,726 hospital discharges reported for the years 1998-2013. In addition, we conducted a systematic review of the English literature to evaluate dialysis practices among men versus women with AKI. Results: Hospitalized men were more likely to develop AKI-D than hospitalized women (OR 2.19 (2.15, 2.22) p < 0.0001). We found no evidence in the published literature that dialysis practices differ between men and women with AKI. Conclusions: Based on a population of hospitalized patients which is more than 3 times larger than all previously published cohorts reporting sex-stratified AKI data combined, we conclude that male sex is associated with an increased incidence of hospital-associated AKI-D. Our study is among the first reports to highlight the protective role of female gender in AKI.
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